Cervical Nerve Entrapment By Kath Fennemore

What is it?

Cervical nerve entrapment occurs when a nerve or nerves originating from the neck become compressed or entrapped by surrounding tissue or bone. It commonly affects people aged 40 to 50, though it can occur outside this range, especially if there is a past history of injury , such as a ‘whiplash’ injury or an assault (Gifford, 2001; Heerenbrink et al., 2024). This compression arises mainly due to age-related changes in cervical vertebrae, such as the formation of bony spurs (osteophytes) that encroach on the nerve exit zones (Bogduk, 2016). The spine remodels roughly every 10 years, but this process slows with age, contributing to narrowing of nerve passageways, which restricts nerve mobility and causes entrapment (Gifford, 2001; Pfirrmann et al., 2006). In younger individuals, disc protrusions into foraminal spaces can also cause nerve compression (Radhakrishnan et al., 1994). Although the exact prevalence of cervical nerve entrapment is not well defined, it likely represents a significant portion of the global neck pain prevalence estimated at 4.7% (Hoy et al., 2014). Not all neck pain indicates nerve entrapment; however, classic symptoms help differentiate it (Gifford, 2001).

How do I know if I have nerve entrapment?

Nerve pain typically presents as burning, shooting, or throbbing sensations. In cervical nerve entrapment, this may manifest as burning or itching between the shoulder blades, accompanied by heaviness or weakness in the ipsilateral arm (Gifford, 2001; Basson et al., 2019). Symptoms may include a deep ache in the upper arm (biceps or triceps regions) or mimic lateral epicondylalgia with sharp radiating pain down the forearm (Basson et al., 2019; Binder, 2007). Carpal tunnel-like symptoms (weakness, pins and needles, loss of coordination in wrists and hands) may also originate from cervical nerve issues rather than local wrist pathology (Maigne and Doursounian, 1997). A common clinical observation is symptom relief by placing the arm overhead, which suggests nerve root involvement (Gifford, 2001; Basson et al., 2019).

What to expect at a Physiotherapy Appointment

Initial evaluation includes a subjective assessment of pain, functional impact, medical history, and lifestyle factors such as work and sports activities (Childs et al., 2008). Objective testing involves active and passive neck, shoulder, arm, and wrist movements; palpation of suspected areas; and neurological tests including myotomes, dermatomes, and reflexes to pinpoint the affected nerve root level (Nee and Butler, 2007). This thorough assessment guides targeted interventions aimed at decompressing the nerve and reducing symptoms.

What does treatment involve?

Treatment focuses on manual therapy techniques, including mobilisations and soft tissue manipulation to improve nerve gliding and reduce compression (Nee et al., 2012; Jull et al., 2002). Electrotherapy and heat may be adjuncts. Therapeutic exercises are prescribed to strengthen cervical muscles and maintain proper posture to sustain foraminal space openness (Jull et al., 2002; Vernon, 2009). Relief may be immediate in some cases but recurrence is common initially, reflecting the nature of the condition (Nee et al., 2012).

Will I need surgery?Surgical intervention depends on severity and response to conservative care. Systematic reviews show that outcomes at six months post-surgery are comparable to six months of physiotherapy, with surgery bearing higher risks (Heerenbrink et al., 2024). Therefore, physiotherapy remains first-line treatment. Most patients experience significant symptom improvement within six months and full resolution within 12 to 24 months, though individual variation exists (Heerenbrink et al., 2024; Rhee et al., 2013).

References

Basson, A. et al. (2019) 'The effectiveness of neural mobilization for neuromusculoskeletal conditions: A systematic review and meta-analysis', Journal of Hand Therapy.Binder, A.I. (2007) 'Cervical radiculopathy', Neurologic Clinics.Bogduk, N. (2016) 'Cervical spine anatomy and pathology: implications for clinical practice', Clinical Anatomy.Childs, J.D. et al. (2008) 'Clinical prediction rules for patients with neck pain: a systematic review', Physical Therapy.Gifford, L. (2001) 'Acute low cervical nerve root conditions: symptom presentations and pathobiological reasoning', Physiotherapy Theory and Practice.Heerenbrink, S. et al. (2024) '(Cost‑)effectiveness of personalised multimodal physiotherapy compared to surgery in patients with cervical radiculopathy: A systematic review', Journal of Physiotherapy.Jull, G. et al. (2002) 'Neck pain disability and cervical muscle performance following mobilization: a randomized controlled trial', Journal of Manipulative and Physiological Therapeutics.Maigne, J.Y. and Doursounian, L. (1997) 'Cervical radiculopathy mimicking carpal tunnel syndrome', Muscle & Nerve.Nee, R. and Butler, D.S. (2007) 'Management of peripheral neuropathic pain: Integrating neurobiology and neurodynamics', Manual Therapy.Nee, R. et al. (2012) 'Cervical radiculopathy: effect of neural mobilization', Journal of Manual & Manipulative Therapy.Pfirrmann, C.W.A. et al. (2006) 'MRI findings of the cervical spine in asymptomatic subjects: prevalence of pathologic findings and age-related changes', Spine.Radhakrishnan, K. et al. (1994) 'Epidemiology of cervical radiculopathy', Neurology.Rhee, J.M. et al. (2013) 'Surgical versus nonsurgical treatment for cervical radiculopathy: a systematic review', Spine.Vernon, H. (2009) 'Cervical lordosis rehabilitation for neck pain and dysfunction using specific cervical manipulation and extension traction', Physical Therapy Reviews.Hoy, D. et al. (2014) 'The global prevalence of neck pain: a systematic review and meta-analysis', Arthritis & Rheumatology.