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Cervical Annular Tears at C5–C6

Dr. Lisa S. Apfel MD - Spine and Neurosurgery Dr. Lisa S. Apfel MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

A cervical annular tear is a crack or fissure in the annulus fibrosus—the tough, outer ring of the intervertebral disc—specifically at the C5–C6 level of the neck. These tears can result from degeneration, trauma, or both, allowing the inner gel-like nucleus pulposus to irritate adjacent nerves and tissues, often causing neck pain, arm pain, or neurological symptoms. NCBI

Anatomy of the C5–C6 Disc

  • Structure & Location: The C5–C6 intervertebral disc sits between the fifth and sixth cervical vertebrae, acting as a cushion and pivot point for neck movement. PhysiopediaDeuk Spine

  • Attachments (Origin/Insertion): The annulus fibrosus attaches circumferentially to the upper and lower vertebral endplates, anchoring the disc in place. RadiopaediaPhysiopedia

  • Blood Supply: Discs are largely avascular; only the outer third of the annulus fibrosus receives tiny vessels from adjacent vertebral bodies. Inner portions rely on diffusion through the endplates for nutrition. PhysiopediaDeuk Spine

  • Nerve Supply: Pain-sensitive nerve fibers (sinuvertebral nerves) penetrate only the outer third of the annulus, making inner tears painless unless they extend outward. PhysiopediaRadiopaedia

  • Functions (6):

    1. Shock Absorption: Distributes compressive loads.

    2. Load Transfer: Evenly spreads forces between vertebrae.

    3. Flexibility: Allows bending and twisting.

    4. Stability: Provides resistance to excessive motion.

    5. Protection: Shields the nucleus pulposus from damage.

    6. Height Maintenance: Keeps proper disc thickness and intervertebral spacing. Spine-healthDeuk Spine

Types of Annular Tears

  1. Peripheral Tears – Start at the outermost rings, often from trauma (e.g., a fall).

  2. Concentric Tears – Lamellae of the annulus separate parallel to their fibers.

  3. Radial Tears – Fissure extends from nucleus outward, often due to degeneration. Florida Surgery Consultants

Causes

  1. Age-Related Degeneration: Natural wear leads to disc weakening.

  2. Degenerative Disc Disease: Accelerated loss of disc hydration and height.

  3. Acute Trauma: Car accidents or falls can crack the annulus.

  4. Sports Injuries: High-impact twisting or collisions.

  5. Repetitive Stress: Bending/twisting in occupations (e.g., assembly work).

  6. Poor Posture: Forward head posture increases disc strain.

  7. Heavy Lifting: Lifting with rounded back multiplies compressive forces.

  8. Occupational Vibration: Heavy machinery use can fatigue disc fibers.

  9. Smoking: Nicotine impairs nutrient diffusion, accelerating degeneration. PMCScienceDirect

  10. Obesity: Extra body weight increases spinal loading.

  11. Genetic Predisposition: Family history raises risk up to six-fold. PMCPMC

  12. Collagen Disorders: Ehlers-Danlos and similar syndromes weaken the annulus.

  13. Dehydration: Poor hydration reduces disc resilience.

  14. Infection: Rarely, discitis can weaken annular fibers.

  15. Inflammatory Conditions: Rheumatoid arthritis can involve discs.

  16. Prior Spinal Surgery: Scar tissue alters biomechanics.

  17. Occupational Strain: Prolonged desk work without breaks.

  18. High-Impact Sports: Football, rugby, gymnastics.

  19. Vibration (Hand-Arm or Whole-Body): Chronic exposure fatigues discs.

  20. Microtrauma: Accumulated tiny injuries over time. Integrative Rehab MedicineSpine Surgery

Symptoms

  • Neck Pain: Often dull, aching, or sharp.

  • Stiffness: Limited range of motion.

  • Radicular Pain: Shooting pain into shoulder or arm.

  • Numbness/Tingling: “Pins and needles” in arm or hand.

  • Muscle Weakness: Gripping or lifting deficits.

  • Headaches: Cervicogenic headaches at base of skull.

  • Shoulder Pain: Referred pain into shoulder blade.

  • Scapular Discomfort: Deep ache around shoulder blade.

  • Muscle Spasms: Involuntary contractions in neck/shoulder.

  • Burning Sensation: Chemical irritation from leaked nucleus.

  • Dizziness: Occasional vertigo from cervical proprioception issues.

  • Tinnitus: Ringing in ears linked to neck pathology.

  • Balance Problems: Rare, from severe nerve involvement.

  • Swallowing Difficulty: If annular tear irritates esophageal nerves.

  • Voice Changes: Very rare, from nerve irritation.

  • Thoracic Pain: Radiating around chest in some cases.

  • Cold Sensation: Cold feeling in arm/hand.

  • Muscle Atrophy: Wasting in chronic cases.

  • Reflex Changes: Altered biceps/triceps reflexes.

  • Sleep Disturbance: Pain worsens at night. Scoliosis Reduction Center®

Diagnostic Tests

  1. MRI (T2-weighted): Shows high-intensity zone (HIZ) in annulus. RadiopaediaNCBI

  2. CT Scan: Detects bony changes and calcified tears.

  3. CT Discography: Contrast injected into disc to reveal leaks.

  4. Provocative Discography: Reproduces pain to confirm symptomatic disc.

  5. X-Ray (Flexion/Extension): Evaluates stability and alignment.

  6. Myelography: Highlights spinal canal and nerve root compression.

  7. Electromyography (EMG): Assesses nerve conduction and muscle response.

  8. Nerve Conduction Studies: Quantifies nerve impulse speed.

  9. Ultrasound Elastography: Emerging technique for annular stiffness.

  10. Somatosensory Evoked Potentials (SSEP): Detects nerve pathway integrity.

  11. Bone Scan: Rules out infection or tumor.

  12. Thermography: Measures skin temperature changes from nerve irritation.

  13. Quantitative Sensory Testing (QST): Evaluates small-fiber nerve function.

  14. High-Resolution CT Myelogram: Detailed nerve root imaging.

  15. Dynamic MRI: Shows movement-related changes.

  16. Plain CT Arthrogram: Rarely used for neck.

  17. Video Fluoroscopy: Assesses real-time motion.

  18. Laboratory Tests: CBC/CRP to rule out infection.

  19. Pain Provocation Tests: Manual palpation and orthopedic maneuvers.

  20. Diagnostic Nerve Blocks: Local anesthetic injection to isolate pain source. PMCAmerican Journal of Neuroradiology

Non-Pharmacological Treatments

  1. Physical Therapy: Strengthening and flexibility exercises.

  2. McKenzie Method: Disc-centralization exercises.

  3. Cervical Traction: Gentle stretching of the neck.

  4. Heat Therapy: Improves blood flow and relaxes muscles.

  5. Cold Therapy: Reduces inflammation and numbs pain.

  6. Transcutaneous Electrical Nerve Stimulation (TENS): Pain modulation PMC

  7. Ultrasound Therapy: Promotes tissue healing.

  8. Manual Therapy: Joint mobilization and manipulation.

  9. Chiropractic Adjustment: Spinal realignment.

  10. Massage Therapy: Reduces muscle tension.

  11. Acupuncture: Traditional Chinese medicine technique.

  12. Yoga & Pilates: Core stabilization and posture.

  13. Ergonomic Corrections: Proper desk/chair setup.

  14. Posture Training: Habit-forming for neck alignment.

  15. Williams Flexion Exercises: Lumbar flexion-based therapy (adapted).

  16. Alexander Technique: Body awareness and movement re-education.

  17. Mindfulness & Meditation: Stress and pain perception reduction.

  18. Cognitive Behavioral Therapy (CBT): Psychological coping strategies.

  19. Dry Needling: Trigger point release.

  20. Hydrotherapy: Aquatic exercises for low-impact movement.

  21. Inversion Therapy: Uses gravity to decompress spine.

  22. Intradiscal Electrothermal Therapy (IDET): Heat to seal fissures.

  23. Percutaneous Laser Disc Decompression: Minimally invasive shrinkage.

  24. Spinal Decompression Table: Mechanical traction.

  25. Ergonomic Pillows: Neck support during sleep.

  26. Soft Cervical Collar: Short-term immobilization.

  27. Weight Management: Reduces overall spinal load.

  28. Post-ural Education: Daily habit modifications.

  29. Nutritional Support: Anti-inflammatory diet.

  30. Hydration Optimization: Maintains disc hydration. ScienceDirectMedscape

Pharmacological Treatments

  1. NSAIDs (Ibuprofen, Naproxen): First-line for pain/inflammation ScienceDirectResearchGate

  2. Acetaminophen: Pain relief with fewer GI risks.

  3. COX-2 Inhibitors (Celecoxib): Lower GI side effects.

  4. Oral Corticosteroids (Prednisone): Short-term inflammation control.

  5. Muscle Relaxants (Cyclobenzaprine): Reduces spasms.

  6. Neuropathic Agents (Gabapentin): For radiating nerve pain PMCPMC

  7. Pregabalin: Similar to gabapentin.

  8. Duloxetine: SNRI for chronic musculoskeletal pain.

  9. Tricyclic Antidepressants (Amitriptyline): Low-dose nerve pain relief.

  10. Topical Lidocaine Patches: Local anesthetic effect.

  11. Capsaicin Cream: Depletes substance P in nerves.

  12. Tramadol: Weak opioid for moderate pain.

  13. Short-Acting Opioids (Codeine): For severe acute pain.

  14. Epidural Steroid Injection (Triamcinolone): Direct anti-inflammatory acc.co.nzAmerican Academy of Orthopaedic Surgeons

  15. Facet Joint Injections (Local Anesthetic + Steroid): Diagnostic & therapeutic Pain Physician JournalAmerican Academy of Orthopaedic Surgeons

  16. Dorsal Root Ganglion Stimulation: Neuromodulation PMC

  17. Botulinum Toxin: Off-label for muscle spasm.

  18. Ketamine Infusion: Refractory neuropathic pain.

  19. Intrathecal Analgesia: For intractable cases.

  20. Bisphosphonates (Alendronate): Theoretical use in bone-related pain. Physiopedia

Surgical Options

  1. Anterior Cervical Discectomy & Fusion (ACDF): Removes disc, fuses vertebrae. NCBI

  2. Cervical Disc Arthroplasty: Artificial disc replacement.

  3. Posterior Cervical Foraminotomy: Nerve-root decompression.

  4. Microdiscectomy: Minimally invasive disc removal.

  5. Endoscopic Discectomy: Tube-based, muscle-sparing removal.

  6. Laminoplasty: Expands spinal canal.

  7. Posterior Laminectomy: Removes lamina to relieve pressure.

  8. Posterior Cervical Fusion: Stabilizes multiple levels.

  9. Anterior Corpectomy: Removes vertebral body and disc.

  10. Percutaneous Laser Disc Decompression: Shrinks disc tissue. Florida Surgery Consultants

Prevention Strategies

  1. Ergonomic Workstation: Monitor at eye level, supportive chair. NJ Spine & OrthopedicWikipedia

  2. Core & Neck Strengthening: Stabilizes spine.

  3. Proper Lifting Techniques: Bend knees, keep back straight.

  4. Posture Awareness: Chin tucks, shoulder retraction.

  5. Regular Exercise: Low-impact cardio & stretching.

  6. Weight Management: Reduces spinal load.

  7. Smoking Cessation: Slows degenerative changes.

  8. Adequate Hydration: Maintains disc health.

  9. Balanced Diet: Rich in vitamins C, D, calcium.

  10. Frequent Breaks: Avoid prolonged static postures. Spine SurgeryWikipedia

When to See a Doctor

  • Pain persisting beyond 6 weeks despite self-care

  • Progressive arm weakness or numbness

  • Loss of bladder or bowel control

  • Severe neck stiffness preventing movement

  • Fever or unexplained weight loss with pain

  • New onset of balance disturbance or gait changes NCBI

Frequently Asked Questions

  1. What exactly is a cervical annular tear?
    A crack in the outer disc ring at C5–C6, letting inner gel irritate nerves. NCBI

  2. Can annular tears heal on their own?
    Small tears may heal or seal over months with conservative care. American Journal of NeuroradiologyNCBI

  3. How is an annular tear different from a herniated disc?
    A tear is a fissure; a herniation is when the nucleus pushes out. Wikipedia

  4. Why does a tear cause arm pain?
    Leaked disc fluid inflames nearby nerve roots (radiculopathy). Integrative Rehab Medicine

  5. Is MRI always needed?
    MRI is best to visualize tears (HIZ) but not always required initially. RadiopaediaPMC

  6. Do I need surgery?
    Only if pain is intractable, neurological deficits progress, or conservative care fails. Medscape

  7. Are steroid injections safe?
    Generally safe, with transient discomfort; infection risk is very low. acc.co.nzAmerican Academy of Orthopaedic Surgeons

  8. Can I work with an annular tear?
    Many continue modifying activities and using therapy without surgery. Physiopedia

  9. What’s the role of posture?
    Good posture reduces strain on C5–C6 and slows tear progression. Spine SurgeryDeuk Spine

  10. Is smoking really a factor?
    Smoking accelerates degeneration and delays healing. PMCScienceDirect

  11. How long does recovery take?
    Conservative treatment may take 6–12 weeks; surgery recovery 3–6 months. Medscape

  12. Can exercise worsen a tear?
    Improper exercise can, but guided physical therapy strengthens supporting muscles. PMCScienceDirect

  13. Is annular tearing painful in everyone?
    No—only when the tear reaches the nerve-rich outer annulus. RadiopaediaAmerican Journal of Neuroradiology

  14. Are there alternative therapies?
    Acupuncture, mindfulness, and spinal decompression show variable benefit. Colorado Secretary of StatePMC

  15. How can I prevent future tears?
    Maintain hydration, posture, core strength, and avoid smoking/heavy lifting. NJ Spine & OrthopedicWikipedia

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 03, 2025.

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  27. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  28. https://www.cdc.gov/niosh/topics/skin/default.html
  29. https://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/syc-20350084
  30. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
  31. https://www.cdc.gov/traumaticbraininjury/index.html
  32. https://www.skincancer.org/
  33. https://illnesshacker.com/
  34. https://endinglines.com/
  35. https://www.jaad.org/
  36. https://www.psoriasis.org/about-psoriasis/
  37. https://books.google.com/books?
  38. https://www.niams.nih.gov/health-topics/skin-diseases
  39. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  40. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  41. https://dermnetnz.org/topics
  42. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  43. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  44. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  45. https://www.nibib.nih.gov/
  46. https://www.nei.nih.gov/
  47. https://en.wikipedia.org/wiki/List_of_skin_conditions
  48. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  49. https://en.wikipedia.org/wiki/Skin_condition
  50. https://oxfordtreatment.com/
  51. https://www.nidcd.nih.gov/health/
  52. https://consumer.ftc.gov/articles/w
  53. https://www.nccih.nih.gov/health
  54. https://catalog.ninds.nih.gov/
  55. https://www.aarda.org/diseaselist/
  56. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  57. https://www.nibib.nih.gov/
  58. https://www.nia.nih.gov/health/topics
  59. https://www.nichd.nih.gov/
  60. https://www.nimh.nih.gov/health/topics
  61. https://www.nichd.nih.gov/
  62. https://www.niehs.nih.gov
  63. https://www.nimhd.nih.gov/
  64. https://www.nhlbi.nih.gov/health-topics
  65. https://obssr.od.nih.gov/
  66. https://www.nichd.nih.gov/health/topics
  67. https://rarediseases.info.nih.gov/diseases
  68. https://beta.rarediseases.info.nih.gov/diseases
  69. https://orwh.od.nih.gov/

References

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