Cervical radiculopathy is a disease of the cervical spine. It is caused due to an irritation to the nerves that emerge from the spinal cord in the neck, and can result in pain, numbness, or tingling in the neck, arm and hand. It is commonly referred to as a “pinched nerve”.
The cervical spine, or neck, is the uppermost portion of the spinal cord, and it is located from the base of the head to the base of the shoulders.
There are seven spinal bones, called vertebrae, in the cervical spine. Between each vertebra is a fibrous cartilage cushion, called an intervertebral disc. This disc acts as a cushion for the vertebrae. Inside each disc is a jelly-like substance called the nucleus pulposus. These discs are thick and healthy in younger populations, and slowly shrink as a person ages, due to material slowly drying out and causing a reduction in thickness. Nerves exit the spinal cord in special holes, called foramen, that are located on the sides of each vertebra. There are eight of these spinal nerves, named C1 through C8, in the cervical spine. These nerves branch out from the neck to innervate specific muscle groups in the neck, upper shoulders and arms; the job of the nerves is to provide the muscles with motor and sensory function.
As in the other levels of the spine, there are intervertebral discs that sit between each of the vertebrae in the thoracic spine. There are 12 vertebrae that make up the thoracic spine. All thoracic vertebrae have a rib attachment and the combination of the ribs and thoracic vertebrae orientation make it very stable. Approximately 75% of all thoracic disc bulges happen from T8-T12. These disc bulges will often cause pain in the thoracic spine that wraps around the ribs as it gets worse. At times pain will be felt in the belly or chest.
Usually there is not a mechanism of injury causing thoracic disc pain but it can be caused by vigorous coughing and sneezing, repeated flexing type work, or motor vehicle accident. Most thoracic disc bulging is caused by degeneration in the lower part of the thoracic spine over time. I often find thoracic disc problems to afflict those that are stiff throughout the spine and have a sedentary lifestyle.
The level of the spine that is affected (T1-T12) will determine where mid-back pain is felt. The first symptom of a thoracic disc problem is most often pain in the mid back. As it gets worse, it can wrap around one or both sides to the chest, can cause leg pain, or even arm pain. If the condition is severe, it can cause “pins and needles” type of pain. In emergency situations, where the disc is pushing into the spinal cord, patients may lose control of bowel and bladder function. This is an emergent situation and patients should go straight to the ER.
If a thoracic disc is bulging, it can be diagnosed via MRI but an X-ray can be used to look at the bone structure. Physicians or Physical Therapists that are evaluating patients with thoracic pain should take a detailed history followed by an objective examination. The examination should include reflexes, sensation, strength testing, and motion assessment. This can help diagnose thoracic arthritis and rule out a compression fracture. If radiating pain is noted the physician will often order tests to evaluate lungs, kidneys and gastrointestinal tract.
In our experience we do not see a lot of thoracic disc problems that require surgery. They typically respond to conservative treatment (Physical therapy) consisting of repeated motion, postural exercises, strengthening, and modalities to control pain. Often when pain is wrapping around one side of the ribs, rotation exercises will really help. The use of extension exercises over a chair or small swiss ball are also effective treatment approaches. If conservative treatment fails, then there are surgical options. Depending on the location of the disc bulge and the surgeon performing the surgery, the technique used can change.
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