Cervical radiculopathy will manifest itself as pain traveling from the neck into a specific region of either arm, forearm or hand. In many instances, this will be accompanied by numbness in a similar distribution or weakness in specific muscles in either the arm, forearm or hand.
The “natural history” of cervical radiculopathy depends in large part on how long the patient has had symptoms for. In patients who present with very early symptoms, the prognosis is generally very good. Most of these patients will have complete resolution of their pain, numbness and weakness over a 6-12 week period.
In patients who have had symptoms for a slightly longer period of time, the prognosis is less clear. Some patients will go onto complete resolution of pain with (and, in some cases, without) limited treatment such as modification of activities, heat, ice, physical therapy or over-the-counter medications. Approximately one third of these patients will have some lingering degree of symptoms that they may be able to cope with. A small percentage will have symptoms that are unbearable and may need further treatment.
Most patients with cervical radiculopathy will be treated initially with non-operative measures. These measures typically include a short period of modification of activities. Modification of activities may include simple techniques such as changing the height of your computer monitor or the height of your chair at work. Applying ice or head to the painful area, or using over-the-counter anti-inflammatory medications judiciously, keeping in mind that overuse of any medication can be accompanied by unwanted side effects.
In patients whose pain is not controlled with these measures, stronger medications such as prescription anti-inflammatory agents, muscle relaxants or narcotic analgesics may be required for a short period of time. Physical therapy is an important part of the rehabilitation process. Your physical therapist will carry out an evaluation of your function, and then instruct you on proper ergonomics and a gentle program of stretching and flexibility. As the pain resolves, mild strengthening exercises will be instituted. A primary benefit of physical therapy conditioning is avoidance of secondary stiffness or inflammation at your shoulder, elbow or elsewhere in the neck and upper extremities, commonly seen in patients who have pain and weakness.
In some patients with cervical radiculopathy, it may be recommended to have injection treatments. Most commonly, these will be epidural steroid injections. These are targeted injections of corticosteroid into the area around the nerve that is inflamed in your neck. The purpose of the injection is to reduce the inflammation and relieve the pain associated with the irritated nerve.
In those patients where nonoperative measures are unsuccessful, surgical measures provide a good option. Surgical intervention for cervical radiculopathy may be either through the front [anterior] or the back [posterior] of the neck, or both the front and back of your neck. Several factors will be considered in choosing the type of surgery you undergo. These will include the exact location of any compression on your spinal cord or nerve branches, the number of levels at which there is compression, the overall alignment of your cervical spine and your overall medical condition.