Pathophysiology

Nerves run from the brain throughout the body, cervical nerve roots names C1-C8 exit the level above the vertebrae named in the neck, except the last one (C8 exits below the C7 vertebra). These cervical nerves then branch out to supply muscles that enable functioning of the shoulders, arms, hands, and fingers. They also carry sensory fibres to the skin that provide us with sensation.

Symptoms

• Pain in the neck and often radiating down the arm/s and into the fingers, this may also include weakness, pins and needles or numbness
• Pain on neck movements, often worse on turning your head and tilting your head towards the side of pain
• Often lasts up to 3 months, nerve healing timeframes are much longer than those of bones, muscles and ligaments and sensory symptoms e.g. pins and needles or numbness often persist longer

Management

• Activity modification
• Ice or heat
• Pain relief- in discussion with GP can include antineuropathic medication (e.g. amitriptyline or gabapentin)
• Physiotherapy to include range of movement exercises and strengthening exercises
• Orthopaedic options include injection if symptoms not improving in expected timeframes

Investigations

Generally no appropriate initially unless symptoms have not improved with conservative management within expected timeframes