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Cervical radiculopathy and referral pain

In particular instances, the anatomical structure of the neck can be the cause of referred pain, a type of pain that is felt elsewhere from the main pathology. In regard to neck injuries, people can often complain of shoulder, elbow and hand discomfort, ranging from pins & needles, to a constant ache or burning sensation.

Whilst this can cause concern, the reason behind this pain is quite simple. The nerves exit the spinal cord via openings called vertebral foramen, which are susceptible to injury. Pathologies which have the potential to narrow these foramina, and cause a resultant nerve irritation, include herniated or bulging discs, joint space narrowing as a result of increased stiffness or degeneration. Due to the peripheral nature of the irritation, these referral symptoms will be unilateral in nature, but in severe cases, patients can feel discomfort in both arms.

Distribution of referral pain

Dermatomes

The location or distribution of referral pain is dependent on the location of the nerve irritation in the spine. As each root supplies sensory and motor input to different areas of the arm, symptoms will usually follow a specific distribution or region of the arm, known as dermatomes. The picture below illustrates these patterns (C = cervical vertebrae, T = thoracic vertebrae, number indicates differing spinal level):

For example, someone with a C6 radiculopathy and corresponding referral pain will often feel symptoms along the outside of their arm, descending to the thumb.

Management of referral pain

Manual therapy has been shown to beneficial for pain relief and improvements with function when combined with exercise interventions. However, as a stand-alone treatment, it has only been shown to provide short term relief.

Exercise therapy has been consistently demonstrated to have the most positive and lasting effects for the condition. Exercises targeted at opening the intervertebral foramen and stabilising the resultant openings through strengthening programs are often the first line of treatment that a physiotherapist will employ. This ensures that both short-term and long-term relief are achieved. Furthermore, your physiotherapist may also include some exercises aimed at reducing the neurological referral symptoms down your arm. Adherence to exercise programs is essential to reducing pain and improving long term function, and as such, your own role in your wellbeing is essential.

Cervical radiculopathy and referred pain can be a scary situation to patients initially, but when managed correctly using a combination of manual therapy, exercise programs and education, the prognosis has been shown to be positive.

Book into Pivotal Motion Physiotherapy and chat to one of our physiotherapists today on 07 3352 5116 if you’re experiencing any symptoms that you think could be related to cervical radiculopathy!