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Pinched nerve in the cervical spine in adults and children
Last reviewed: 12.03.2022
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If in everyday life they say “pinching of the cervical nerve”, then a more accurate medical formulation is the definition: pinching of the roots of the cervical spinal nerves or the nerve root of the cervical plexus. And this is one of the most common causes of neurological problems associated with the neck.[1]
Causes of the pinched nerve root of the cervical plexus
In the posterior triangle of the neck (scapulo-trapezius), opposite the four upper cervical vertebrae (under the sternocleidomastoid muscle), there is a network of anterior branches of the CI-CIV spinal nerves connected to each other, emerging from the spinal cord of the cervical spine through the intervertebral (foraminal) holes. This local nerve network, called the cervical plexus , is part of the peripheral nervous system.
Each of these nerves originates from motor (anterior) and sensory (posterior) roots - axons or processes of the corresponding neurons, which, leaving the foraminal opening, are connected together into mixed fibers (conducting efferent and afferent impulses).
The first three cervical nerves (CI, CII and CIII) are associated with movements of the head and neck; dermatome CII provides sensation to the upper part of the head, and dermatome CIII provides sensation to the back of the head and part of the face.
The cervical plexus forms smaller nerve branches. Thus, the superior roots of CI-CII and the inferior roots of CII-CIII form the neural loop of Ansa cervicalis, which provides innervation of the hyoid muscle involved in swallowing and articulation. Several other branches arise from the nerve roots of the cervical plexus (small occipital and large auricular nerves, transverse cervical and supraclavicular nerves) and provide motor innervation to the skeletal muscles of the neck, as well as sensory innervation (skin sensations) in parts of the occiput, neck, and shoulder. In addition, sympathetic sudomotor and vasomotor nerve fibers pass through the cervical plexus to the blood vessels and sweat glands.[4]
The main causes of pinched cervical nerves are associated with:
- injuries of the cervical spine ;
- disc protrusion between the vertebrae of the neck or herniated disc ;
- degenerative changes in the spine, for example, with cervical osteochondrosis ;
- spondylarthrosis localized in the cervical spine ;
- cervical spondylosis or with diffuse idiopathic skeletal hyperostosis ;
- hypertrophy of the facet joints of the vertebrae, leading to cervical facet syndrome ;
- development of spinal cord tumors .
In addition to injuries and neoplasms localized in the cervical spine (primarily perineural cysts), pinching of the cervical nerve in a child may be due to congenital nonunion of the cervical vertebral arches - spondylolysis.
Due to an injury received during childbirth (when passing through the birth canal), with short neck syndrome or congenital muscular torticollis , as well as due to careless handling of the baby (who begins to hold his head only by 2.5-3 months), the cervical vertebrae may shift, which causes pinching of the cervical nerve in newborns.[5]
Risk factors
In fact, pinching of any nerve is a pathological process, and, in addition to the already listed reasons for its development, experts include the risk factors for pinched nerves in the cervical spine: a decrease in bone mineral density, which increases the likelihood of spinal column injuries (spontaneous fractures); in children - rickets; in adults - degenerative-dystrophic pathologies of the vertebral joints of the neck; ankylosing spondylitis; kyphosis of the cervical spine , hypertrophy of periradicular fibrous tissues, prolonged posture disorder, etc.
Pathogenesis
The mechanism of action on the motor and sensory nerve roots of the cervical plexus (vulnerable to damage due to the poorly developed connective tissue sheath - epineurium) lies in the violation of the functions of the peripheral nervous system, that is, there is a violation of nerve conduction.[6]
In more detail, the pathogenesis of pain that occurs during compression of the cervical nerves and stenosis of the intervertebral foramen is discussed in the publication - Neuropathic pain. [7]
In adults, cervical osteochondrosis and pinched nerves are most often combined. More information in the material - Osteochondrosis of the spine: neurological complications
Symptoms of the pinched nerve root of the cervical plexus
When the nerve root of the cervical plexus is pinched, cervical radiculopathy develops (from Latin nervi radix - nerve root) or neuralgia , and its first signs are manifested by neck pain - behind and on the side.
Pain when a nerve is pinched in the cervical region can be dull, aching or burning and shooting - at rest, as well as with flexion-extension of the neck and turning the head. In later stages, radiating pain in the fingers and hands appears.
In addition, neuralgic symptoms include restriction of movement in the cervical spine and impaired sensitivity - paresthesia, which is manifested by skin numbness and tingling, spreading to the neck and back of the head, shoulder and collarbone, submandibular region and upper shoulder blades. In most cases, cervical radiculopathy manifests itself on the one hand, but bilateral symptoms are also possible.[8]
Also, the head often hurts when a nerve is pinched in the cervical region, and with a lack of oxygen entering the brain with blood flow, there is dizziness when the cervical nerve is pinched and even fainting.
While movement disorders due to pinching of the cervical spinal nerves are rare (because the muscles controlled by them are characterized by increased innervation), motor problems can still be observed: with compression of CI-CII, flexion-extension of the neck is difficult; limited lateral flexion of the neck when tilting the head (with pinching CIII); shoulder elevation and abduction (CIV-CV), elbow flexion and wrist extension (CVI), elbow extension and wrist flexion (CVII), and thumb extension (if the CVIII cervical nerve root is compressed) may be difficult.[9]
More information in the article - Symptoms of lesions of the cervical plexus and its branches
Complications and consequences
Among the characteristic consequences and complications are: numbness of the fingers and weakening of the hands; development of cervical migraine (chronic throbbing headache with dizziness and tinnitus) - Barre-Lieu syndrome ; development of paraparesis and paraplegia.
There may also be a reduction in the length of the muscles of the cervical spine and its weakening, stiffness of the joints, persistent posture disorders.
Diagnostics of the pinched nerve root of the cervical plexus
To make a diagnosis, a physical examination of the patient, fixation of his complaints and a complete history are necessary.
Instrumental diagnostics is used for visualization:
- x-ray of the cervical spine with spondylometry ;
- MRI or computed tomography of the neck ;
- ultrasound of the nerves ;
- electromyography.[10]
Differential diagnosis
Specialists also carry out differential diagnosis with vertebrobasilar syndrome having a vascular etiology; with cervical myofascial pain syndrome with neck myositis or myogelosis; with demyelinating polyneuropathies (including syringomyelia), as well as peripheral motor neuropathies in focal CNS lesions and motor neuron diseases; with neuralgic amyotrophy (Parsonage-Turner syndrome), etc.[11]
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Treatment of the pinched nerve root of the cervical plexus
Etiological treatment is aimed at the cause of pinching, that is, it is necessary to treat cervical osteochondrosis , displacement of the vertebrae, or treatment of vertebral hernia .
Symptomatic treatment consists in the fact that the doctor prescribes an anesthetic for a pinched cervical nerve.[12]
First of all, these are such tablets as: Paracetomol, Ibuprofen (Ibuprom, Ibufen, Nurofen, Imet, etc.), Ketanov, Diclofenac and preparations containing diclofenac sodium; Renalgan (Maksigan). Also read - Pills for neuralgia.
Vitamins B1, B6 and B12 may be prescribed.
Treatment at home is carried out using local remedies, these are gels and ointments: Menovazan , Deep Relief and Dolgit (with ibuprofen), products with nimesulide or ketoprofen. For more details, see - Ointments for neck pain
With a severe pain syndrome, painkillers are also prescribed for pinching the cervical nerve - peri- or paraneural novocaine blockade .
Read more in the publication - Treatment of neuropathic pain
The standard treatment for movement problems in nerve conduction disorders is physiotherapy, see - Physiotherapy for neuritis and neuralgia of peripheral nerves
Patients are prescribed therapeutic massage (to improve muscle trophism) and special gymnastics for pinched cervical nerve - to maintain the existing range of motion. It is necessary to systematically perform such exercises for pinching the cervical nerve as contralateral rotation and lateral tilts of the neck while standing or sitting, raising the head with anterior flexion of the neck in the prone position, isometric exercises for the muscles of the upper limbs, etc.
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In cases of low efficiency of conservative therapy and a clear motor deficit, surgical methods are resorted to: anterior discectomy or corpectomy (decompression) of the cervical vertebra, arthroplasty of the intervertebral disc, laminotomy or foraminotomy.
Prevention
Is it possible to prevent pinched nerves? If you do not injure the cervical spine, monitor your posture, adhere to a healthy and physically active lifestyle, then the risk of developing this pathology can be reduced.
Forecast
In the case of pinching of the cervical nerve - the nerve root of the cervical plexus, the prognosis of its outcome and neurological consequences is directly related to the cause. [13]Unfortunately, the consequences can be chronic (irreversible) in nature.