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Cervical radiculopathy is a pain syndrome involving one of the cervical nerve roots, with the C7 root (60%) and the C6 root (25%) being the most commonly involved. In younger persons this is due a direct injury which compromises the nerve exit or due to an acute disc prolapse. In older age groups this syndrome can also occur, but in this case is due to narrowing of the nerve exit by arthritic joints and ligament enlargement, disc bulging and bony outgrowths. Cervical nerve root pain referred to physiotherapists for the management of neck pain and arm pain.

Risk factors for this type of neck pain and arm pain include smoking, lifting heavy weights regularly (e.g. 12kg, 25 pounds) and driving or operating vibrating equipment. Overall cervical radiculopathy is uncommon and much more so than lumbar disc syndromes such as sciatica. The discs between the vertebrae from C2 to C7 transmit loads down through the spine and dissipate some of the forces applied to it. At the side of the vertebrae are the nerve exits or foramina and the nerve takes up to a third of the exit space normally. Degenerative changes in any of the structures which surround and form the walls of the exit can compromise the exit channel itself and compress the nerve.

There can be many reasons for the onset of nerve root neck pain or it can come on slowly without clear reason. If the neck is moved backwards, tipped to one side and rotated to the same side this can sharply narrow the nerve exit space and injure the nerve, occurring in a traumatic accident or a sporting injury. The opposite can occur with a quick side bend, combined with flexion or extension, tractioning the nerve and causing injury. Sudden loading of the neck in any posture can cause disc prolapse. There may be degenerative changes in an older group and with repetitive or sustained neck postures an osteophyte can impinge the nerve and give a slower development of arm pain.

The onset of cervical radiculopathy can be insidious without obvious cause or after an incident. During sport or trauma like a fall the neck can be extended back, bent to one side and rotated, suddenly narrowing the exit for the nerve and compressing it, causing an injury. Or a sudden bend to the opposite side with either cervical flexion or extension can traction the nerve on the one side with consequent injury again. If there is a sudden load on the cervical spine, in any position, it's possible for a disc prolapse to occur. If there are osteophytes present in an older person, sustaining or repeating extension with rotation may cause nerve irritation with a slower onset.

Typically the pain comes on slowly and steadily with neck and arm discomfort, ranging from dull ache to a severe pain. Initially the complaint is shoulder pain, progressing to scapular, upper arm, lower arm and hand pain as the syndrome worsens. Changes in sensibility and motor power can also be present, in some cases without significant pain.

On physiotherapy examination patients look tired as they have not slept and they lose their sense of humour. They may hold their arm in a relieving posture cradled across the body or with the elbow out to the side and the hand behind the neck or over the head towards the opposite ear. This may reduce the tension through the irritated or compressed nerve root, reducing the pain.

Patients hold their necks stiff and have reduced movement with postural deformity such as a head tilt or rotation away from the painful side. Physiotherapy testing includes checking muscle spasm, testing muscle strength, reflexes and sensory abilities. Manual traction may help symptoms and this and movement combinations which aggravate the pain are noted.

Initially the physiotherapist concentrates on reduction of the pain and potential inflammation, using ice, non-steroidal anti-inflammatory drugs and other analgesia, avoiding aggravating postures and activities, manual or mechanical traction. The aim of treatment is to reduce the forces going through the nerve root and to allow it to settle. A collar for support and to reduce movement, especially at night, can be useful. Manual traction is a physiotherapy skill which needs to be carefully applied if it is not to worsen the condition. Once the acute phase is over the physio turns to restoring range of movement and neck and overall muscle power, beginning with isometric exercises and progressing. Patients should keep up strengthening, stretching and cardiovascular fitness over the long term.