What is it?
Sharp stabbing pains that run down an arm; tingling and numbness in the fingers; or a wince as your patient twists their neck. These are all are symptoms of Cervical Radiculopathy.
Typically, the first time your patient is aware of anything going wrong is in an unprovoked attack. It can start off feeling just like a cricked neck followed by an acute stabbing or burning sensation. Twisting their neck from side to side may exacerbate the condition.
There are two primary causes:
- A rupture of a cervical disc causing the soft nucleus to herniate and aggravate the nerve running past the disc.
- Cumulative wear and tear of the discs in the neck (typically C6 or C7). The degeneration becomes chronic, and the associated bony spurs impinge on the nerve.
Either way, your patient can experience significant discomfort and at times, excruciating pain.
For most of your patients, the natural history will be benign, symptoms resolve over a few weeks. In the initial stages, it comes down to your confidence in diagnosing the condition, coupled with your reassurance of the patient.
1. At this stage, a scan is of little value because it does not change advice. The high recovery rate (80+ per cent) means the initial treatment is conservative. That is pain relief and a review of the patient's symptoms in two to three weeks.
Just as important is your reassurance to the patient. That this is probably a temporary condition which, while uncomfortable, does resolve itself.
2. Pain relief is individual and dependent upon the patient's pain threshold. Treatments range from:
- Paracetamol and anti-inflammatories
- To judicious, limited short term use of opioids such as Panadeine Forte, where appropriate.
3. Rest does not help. Light activity, such as standing or walking, is more comfortable than sitting. Going to work is just as good as staying at home.
The only exception to this is a significant loss of function, in which case send them in for a consultation immediately.
Should acute pain persist
The rule of thumb is that the pain does decrease sometime between 3-6 weeks.
If the pain is still severe after this time, a spinal surgeon consult would be appropriate, and an MRI scan* useful.
At this point, surgery is a reasonable and practical option to be discussed with the patient. However, it requires balanced consideration, and my role is to help the patient make an informed decision.
What if there is severe neurological loss?
If you are ever concerned about marked weakness or numbness in the patient, then an early MRI* and referral for a spinal opinion is appropriate.
* MRI scans are costly but do not let that stop your patient. If it is an issue, do contact my practice on the number below and I can arrange an MRI scan by personal request.
If you have any questions about a patient, please feel free to get in touch on 02 9650 4893. I will return your call and discuss how we can help.
You can also reach me via firstname.lastname@example.org.
Further Resources for Referrers available on my website include:
- Management Regime for Lumbar Disc Herniation & Sciatica
- Why your patients might be struggling to walk (Lumbar Canal Stenosis)
- Adult Spinal Deformities: Symptoms & Treatments
- Vertebroplasty – worth a rethink
- Caring for your patients in a Covid-19 world
Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients. Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.
As a teacher Dr Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.
As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.
Posted 19 May 2020