Cervical Radiculopathy

Ever had pain radiating from your neck to your shoulder and down your arm? Perhaps losing strength in your arm or a feeling of numbness or tingling in the fingers? Chances are that you have irritated a nerve in your neck and that nerve is sending these painful or distressing symptoms down your arm.

The neck, or cervical spine, is comprised of the top seven vertebrae of the spine. These vertebrae form a solid yet fluid structure – solid to encase the spinal cord which runs down the centre of the spine, and fluid as the vertebrae move on each other as the neck bends and rotates. In between each vertebrae there is a opening called the intervertebral foramen, and it is here where the nerves that branch off the spinal cord exit the spine. These are called the nerve roots and the ones from the lower half of the cervical spine combine to form a group of nerves that travel into the arm, giving us sensation and muscle power.

Each nerve will follow a specific pathway from the neck to the arm, and nerves like to have space to slide and glide along that pathway. If at any point the nerve is compressed or pinched, then the nerve signal can be affected and as a result we can experience some of the symptoms mentioned above – pain, altered sensation, or reduced power in the arm.

There are certain areas where the nerve is more likely to become pinched in the neck. The intervertebral foramen that it travels through to exit the spine is the first. Anything that encroaches on the foramen such as a disc bulge or a bone spur can reduce the space available for the nerve causing compression. Then once it is through the foramen, the nerve travels between some tightly packed muscles in the neck so any increase in tension in these muscles can also cause compression of the nerve as it moves through this area.

If these symptoms ring a bell with you, a physiotherapist can perform a series of tests that will determine exactly which nerve is irritated and exactly where it is getting pinched. The location of your symptoms or the specific muscles that have lost power will help to determine the area of your neck that needs to be treated. There are several treatment options to resolve your symptoms, and which treatment will be most effective for you will depend on the findings from the assessment. Some common techniques used to treat cervical radiculopathy are manual therapy to create more space for the nerve, traction to take the pressure off the nerve, and acupuncture to stimulate the nerve in order to fully restore the nerve signal. Once there is no compression on the nerve and any inflammation around it has settled, then your arm symptoms should subside and full function should be restored.

Classification of Whiplash Injuries

Classification of Whiplash Injuries

Physiotherapy » Category: "Shoulders" (Page 2)

Classification of Whiplash Injuries

Motor vehicle accidents (MVA) are sometimes an unfortunate consequence of modern reliance we have on automobile transportation. Previous to the invention of the car, there was “railroad neck”, and also a whiplash variation termed “roller-coaster neck”. Motor Vehicle accidents are sometimes termed “motor vehicle crashes” to suggest the preventable nature of some accidents. When a crash does occur, there is usually a chain of events including visits to the auto body shops, ongoing communication with insurance claims agents, and visits to many different health care professionals.

Despite advancement in sophisticated safety equipment for cars, bodily injury can sometimes result from accidents. Although the impact can occur in less than a second, the resulting injuries can persist for weeks or months. The neck (cervical spine) is the most common area of involvement, however, the mid back or low back can also sustain trauma. The shoulder or chest area can also be bruised by the restraint effect of the seat belt.

Injuries to the cervical spine are termed “whiplash-associated disorder’ or WAD for short. As with most conditions and injuries, there is a spectrum of severity. Following much consultation, the Quebec Task Force on Clinical Classification of WAD developed a five point scale of severity in 1995, which is well recognized within the health care and insurance fields. With Grade 0, or WAD 0, there are no physical signs, and the person does not complain of symptoms or usually seek help. At the other extreme end of the spectrum is the most severe WAD IV injury in which X-rays indicate a fracture or dislocation and require urgent medical attention. WAD classification is determined by a detailed and comprehensive clinical examination. Fortunately, most of the whiplash injuries sustained in a crash are classified as WAD II or III, and are commonly treated in physiotherapy practice. Clinical features include pain, and limited range of motion due to muscle spasm, sprained ligaments, and inflamed joints. Irritation of the neurological system can manifest as symptoms of numbness or tingling extending into the upper or lower extremities.

Physical therapists are very familiar with performing a detailed assessment and can help with determining the degree of injury that a person has sustained. A physiotherapy treatment plan is determined based on the degree of injury and time since the accident. Early in treatment when the condition is still very acute, it is common to suggest use of ice to decrease inflammation and pain relieving physical electrical modalities can also be used. As the person’s symptoms decrease, gentle mobilization, range of motion exercises, and progressive strengthening exercises are commonly introduced. Progress with treatment is individual and dependent on many factors. There are numerous practice guidelines, however, which suggest a return to normal daily activities as soon as possible, and treatment that promotes return of function is most helpful. A physical therapist is well trained to help assess your whiplash condition and provide an individualized treatment plan.


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The Frozen Shoulder

Frozen shoulder is a condition that gets its name from the way it causes a gradual stiffening of the shoulder joint, ‘freezing it up’. The proper term for this condition is adhesive capsulitis – adhesive implying stuck and capsulitis meaning inflammation of the capsule.

Although a very common condition affecting approximately 2% of the population, the exact cause of frozen shoulder remains a mystery. In most cases there is a trigger such as straining the shoulder that then develops into a frozen shoulder, but in many cases it is idiopathic i.e. it just happens. When it is triggered, the capsule – that is the connective tissue sack – that surrounds the shoulder joint undergoes a change in elasticity from being somewhat loose and stretchy to being tight and without much stretch.

When it does happen, it follows a distinct pattern of which there are three stages.

The first stage is the freezing stage and is characterized by the onset of a quite intense pain in the shoulder and upper arm and a gradual seizing up of the shoulder. It becomes very difficult and painful to lift the arm up, rotate it outwards, or reach behind your back. This stage typically lasts about 3-6 months then frozen shoulder moves into stage two, the frozen stage, in which the pain starts to subside but the stiffness remains. The shoulder will begin to feel more comfortable in stage 2 but as it is still very stiff, its function remains limited. Again stage 2 can last anywhere between 3 and 6 months before progressing onto stage 3, the thawing stage, when the stiffness finally begins to resolve and the shoulder range of motion is restored.

Although every frozen shoulder will go through these 3 stages, the duration of each stage can vary in each case. Most of the time a full recovery will be made but occasionally full pain-free range of motion does not return. In order to optimize recovery, physiotherapy can help to restore range of motion with techniques such as mobilizations and muscle energy techniques. A prescribed home exercise program is also important so that you can work on stretching the shoulder every day at home. Along with this there are many treatments the physiotherapist is able to do to help control the pain particularly in the early stages of frozen shoulder. This will enable a much more effective stretching regime, which can ultimately lead to a quick and fuller recovery.