Cervical Transverse Nerve Root Compression at C5 – C6

Cervical transverse nerve root compression at the C5–C6 level is a specific form of cervical radiculopathy in which the C6 spinal nerve root becomes pinched or irritated as it exits the spinal canal through the intervertebral foramen between the fifth and sixth cervical vertebrae. This compression can result from mechanical factors such as herniated disc material, bone spurs, or thickened ligaments that narrow the foramen and press on the nerve root, leading to pain, numbness, and weakness along the path of the affected nerve Cleveland ClinicPhysiopedia.

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Anatomy

Structure

The cervical nerve root consists of dorsal (sensory) and ventral (motor) rootlets emerging from the spinal cord. These rootlets converge to form the nerve root proper, which then passes through the intervertebral foramen. Under normal conditions, this root travels in a small bony tunnel protected by vertebral bone, ligaments, and facet joints Spine-health.

Location

At the C5–C6 level, the C6 nerve root exits the spinal canal above the C6 vertebral pedicle, passing through the neural foramen created by the inferior notch of C5 and the superior notch of C6. The root lies just lateral to the uncovertebral joints and deep to the facet joints, making it susceptible to foraminal narrowing Spine-health.

Origin

The C6 nerve root originates from the spinal cord segment at approximately the C5 vertebral level. Multiple small rootlets arise from the dorsolateral and ventrolateral aspects of the spinal cord, representing sensory and motor fibers, respectively, which then exit laterally through the dura Spine-health.

Insertion

After exiting the foramen, the sensory (dorsal) and motor (ventral) roots merge to form the mixed spinal nerve trunk. This trunk subsequently contributes fibers to the brachial plexus, ultimately giving rise to peripheral nerves such as the median and radial nerves, which innervate muscles and skin distal to the arm Spine-health.

Blood Supply

The nerve roots receive their blood supply mainly from radicular arteries—branches of the vertebral, ascending cervical, and deep cervical arteries. These radicular vessels enter the intervertebral foramen alongside the nerve root, supplying both the root and adjacent meninges. Compromise of these vessels can exacerbate nerve root ischemia in compression syndromes NCBI.

Nerve Supply

The C6 nerve root contributes motor fibers that innervate key muscles such as the wrist extensors (extensor carpi radialis longus and brevis) and partially the biceps brachii and brachioradialis. Sensory fibers from this root supply the skin over the lateral forearm and the radial side of the thumb. Reflex arcs mediated by C6 include the biceps and brachioradialis reflexes Spine-health.

Functions

1. Elbow Flexion – Activates the biceps brachii and brachioradialis to bend the elbow.

2. Wrist Extension – Powers the extensor carpi radialis muscles to lift the back of the hand.

3. Forearm Supination – Assists in rotating the forearm so the palm faces upward.

4. Biceps Reflex – Mediates the biceps tendon reflex, providing diagnostic feedback on root integrity.

5. Lateral Forearm Sensation – Delivers sensory information from the skin along the thumb side of the forearm.

6. Thumb Sensation – Conveys touch, pain, and temperature signals from the radial aspect of the thumb Spine-health.

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Types of C5–C6 Nerve Root Compression

Compression at C5–C6 can be classified by the underlying mechanism or anatomical location:

1. Herniated Disc (Prolapse)
   Nucleus pulposus protrudes through the annulus fibrosus, pressing on the ventral nerve root in the foramen Physiopedia.

2. Osteophytic Foraminal Narrowing
   Bone spurs from degenerative spondylosis encroach into the neural foramen, compressing the nerve Expert Health Care MD.

3. Ligamentum Flavum Hypertrophy
   Thickening of the ligamentum flavum reduces the diameter of the lateral recess where the root travels.

4. Facet Joint Arthropathy
   Enlarged or irregular facet joints impinge on the nerve root as it exits the foramen.

5. Spondylolisthesis
   Slippage of one vertebra over another narrows the foramen and stretches the nerve root.

6. Traumatic Fracture/Dislocation
   Acute injuries may displace bone fragments or dislocate the facet joints, directly injuring the root.

7. Synovial Cyst
   Ganglion-like cysts originating from the facet joint capsule can compress the root.

8. Tumors (Neoplastic)
   Extradural or intradural tumors, such as schwannomas or metastases, may occupy space in the foramen.

9. Epidural Abscess
   Infection and abscess formation can lead to inflammatory compression of the root.

10. Rheumatoid Pannus Formation
    Inflammatory tissue proliferation in rheumatoid arthritis can invade the foramen.

11. Congenital Foraminal Stenosis
    Developmental narrowing of the foramen predisposes roots to compression.

12. Iatrogenic Injury
    Post-surgical scar tissue from cervical procedures may tether and compress the root.

13. Disc Sequestration
    Free disc fragments migrate into the canal or foramen and press on the root.

14. Epidural Lipomatosis
    Excess fatty tissue in the canal may bulge into the foramen.

15. Calcific Tendinitis
    Calcium deposits in adjacent soft tissues can encroach on the foramen space.

16. Osteochondroma
    Benign bone tumor on the vertebral border can press on the nerve as it exits.

17. Arachnoid Cyst
    Fluid-filled sac in the subarachnoid space may expand and impinge the root.

18. Thoracic Outlet Syndrome
    Though proximal, tight scalene muscles may stretch or compress roots as they ascend.

19. Chemical Radiculitis
    Inflammatory cytokines from a degenerated disc may irritate the nerve root without frank mechanical compression.

20. Neurofibromatosis
    Growth of nerve sheath tumors along the root can distort and compress it.

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Causes

Below are detailed descriptions of each common cause:

1. Degenerative Disc Disease
   Over time, cervical discs lose hydration and height, causing bulging that narrows the neural foramen and compresses the C6 root.

2. Cervical Spondylosis
   Age-related wear of vertebral joints leads to osteophyte formation and ligament thickening, gradually impinging on exiting roots.

3. Herniated Nucleus Pulposus
   The jelly-like center of the disc pushes through a weakened annulus fibrosus, directly pressing on the root.

4. Facet Joint Hypertrophy
   Chronic stress on facet joints results in bony enlargement that encroaches on the foraminal space.

5. Uncovertebral Joint Arthrosis
   Bony changes at these lateral vertebral joints produce spurs that invade the adjacent neural foramen.

6. Ligamentum Flavum Thickening
   In response to degeneration, this ligament may ossify or bulge inward, reducing space in the lateral recess.

7. Spondylolisthesis
   Forward slippage of C5 on C6 alters vertebral alignment and impinges the C6 root as it exits the foramen.

8. Traumatic Whiplash Injury
   Sudden flexion-extension forces can sprain ligaments or fracture facets, causing acute root compression.

9. Synovial Cyst Formation
   Degenerative facet joints can develop fluid-filled cysts that extend into and press upon the foramen.

10. Rheumatoid Arthritis
    Immune-mediated inflammation produces pannus tissue that can ingress into the foramen and irritate the root.

11. Metastatic Disease
    Cancer cells spreading to the vertebral bodies or epidural space may form masses compressing the root.

12. Spinal Epidural Abscess
    Bacterial infection in the epidural space can lead to localized abscesses that compress nearby nerve roots.

13. Congenital Stenosis
    Naturally narrow foramina in some individuals predispose to early root compression with minor degenerative change.

14. Iatrogenic Scarring
    Surgical interventions on the cervical spine may leave scar tissue that entraps the nerve root.

15. Disc Sequestration
    Fragments of a herniated disc can separate completely and migrate to the foramen, exerting pressure.

16. Osteochondroma
    Benign bone tumors on the vertebral margins may protrude into the foramen causing chronic compression.

17. Arachnoid or Meningeal Cysts
    Fluid-filled sacs in the subarachnoid space can expand and compress the nerve root from the inside.

18. Epidural Lipomatosis
    Excess fatty tissue accumulation in the epidural space may extend into the foramina and compress roots.

19. Calcific Tendinitis of the Neck
    Calcium deposits from chronic tendon inflammation near the foramen can press on the root.

20. Neurofibromatosis-Related Tumors
    Multiple nerve sheath tumors may develop along the root, gradually impinging on its function.

Causes compiled with reference to degenerative and compressive mechanisms commonly outlined in clinical guidelines AAFPAmerican Academy of Orthopaedic Surgeons.

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Symptoms

Compression of the C6 nerve root at C5–C6 can produce a wide variety of signs in the neck, arm, and hand:

1. Neck Pain
   Localized aching or sharp pain around C5–C6 that worsens with movement.

2. Radiating Arm Pain
   Shooting or burning pain traveling down the lateral arm toward the thumb.

3. Shoulder Pain
   Aching discomfort in the deltoid region due to shared innervation.

4. Muscle Weakness
   Difficulty flexing the elbow or extending the wrist against resistance.

5. Numbness
   Loss of sensation or tingling in the thumb and lateral forearm (C6 dermatome).

6. Paresthesia
   “Pins and needles” or electric sensations in the same distribution.

7. Reflex Diminution
   Reduced or absent biceps or brachioradialis reflex on the affected side.

8. Hand Clumsiness
   Difficulty grasping or manipulating small objects due to motor impairment.

9. Sensory Loss
   Decreased light touch or pinprick sensation over the thumb and lateral forearm.

10. Atrophy
    Long-standing compression may lead to wasting of the biceps or forearm muscles.

11. Neck Stiffness
    Reduced range of motion in rotation or lateral bending due to pain.

12. Muscle Spasm
    Involuntary contractions of the paraspinal muscles at the same level.

13. Postural Changes
    Head tilt or shoulder elevation to relieve nerve tension.

14. Radiographic Tenderness
    Point tenderness over the C5–C6 facet on palpation.

15. Sensory Over-Responsiveness
    Heightened sensitivity to light touch (allodynia) in some cases.

16. Burning Sensation
    Neuropathic burning pain felt in the arm or thumb.

17. Cold Sensation
    Abnormal perceptions of cold in the affected dermatome.

18. Hyperalgesia
    Increased pain response to normally painful stimuli.

19. Balance Difficulty
    Rarely, nerve root irritation can cause proprioceptive disturbances leading to minor balance issues.

20. Sleep Disturbance
    Pain and paresthesia often worsen at night, disrupting rest.

Symptom patterns derived from clinical presentations described in American Family Physician and Physiopedia AAFPPhysiopedia.

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Diagnostic Tests

Accurate diagnosis involves a combination of clinical evaluation and imaging or electrodiagnostic studies:

1. Patient History
   Detailed account of symptom onset, distribution, and aggravating factors.

2. Physical Examination
   Assessment of range of motion, manual muscle testing, reflex testing, and sensory mapping.

3. Spurling’s Test
   Lateral neck extension and axial compression to reproduce radicular pain.

4. Neck Distraction Test
   Relief of symptoms when gentle traction is applied to the head, indicating nerve root involvement.

5. Magnetic Resonance Imaging (MRI)
   Gold standard for visualizing soft tissue structures—discs, ligaments, and nerve roots.

6. Computed Tomography (CT) Scan
   Detailed bone imaging to identify osteophytes or foraminal narrowing.

7. CT Myelography
   CT performed after intrathecal contrast to enhance visualization of nerve root impingement.

8. Electromyography (EMG)
   Measures electrical activity in muscles to detect denervation patterns consistent with C6 root compression.

9. Nerve Conduction Study (NCS)
   Assesses conduction velocity in peripheral nerves to differentiate radiculopathy from peripheral neuropathy.

10. X-ray (Cervical Spine Series)
    Initial imaging to assess vertebral alignment, degenerative changes, and gross deformities.

11. Flexion-Extension Radiographs
    Dynamic views to identify instability or spondylolisthesis.

12. Ultrasound
    Emerging modality to visualize superficial nerve roots and guide injections.

13. Somatosensory Evoked Potentials (SSEPs)
    Measures conduction along sensory pathways to localize lesions.

14. Selective Nerve Root Block (Diagnostic Injection)
    Local anesthetic injected around the root to confirm it as the pain source.

15. Bone Scan
    Highlights areas of increased metabolic activity (e.g., infection, tumor) in vertebrae.

16. CT-Based 3D Reconstruction
    Advanced imaging to assess complex foraminal morphology.

17. Dynamic MRI
    Imaging performed in positions of flexion or extension to evaluate positional compression.

18. Inflammatory Marker Tests
    Blood tests (ESR, CRP) to rule out infection or inflammatory arthropathies.

19. Cancer Screening Panels
    When neoplastic cause is suspected, tumor markers and whole-body imaging may be performed.

20. Electrodiagnostic-guided Ultrasound
    Combines EMG/NCS data with ultrasound targeting for precise localization of nerve pathology.

Diagnostic approach based on guidelines from AAFP and Electromyography studies AAFPAmerican Academy of Orthopaedic Surgeons.

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Non-Pharmacological Treatments

Conservative measures play a central role in managing C5–C6 nerve root compression:

1. Activity Modification
   Avoiding movements and activities that exacerbate symptoms, such as overhead lifting or prolonged neck flexion.

2. Cervical Immobilization Collar
   Short-term use of a soft collar to limit motion and relieve mechanical stress on the root.

3. Physical Therapy
   Guided exercises to improve flexibility, strengthen supportive musculature, and correct posture.

4. Cervical Traction
   Mechanical or manual traction to decompress the neural foramen and reduce root impingement.

5. Heat Therapy
   Application of warm packs to relax paraspinal muscles and increase local blood flow.

6. Cold Therapy
   Ice packs to reduce inflammation and alleviate local pain.

7. Ultrasound Therapy
   Therapeutic ultrasound waves to promote tissue healing and reduce pain.

8. Electrical Stimulation (TENS)
   Transcutaneous electrical nerve stimulation to modulate pain signals.

9. Chiropractic Manipulation
   Gentle cervical adjustments aimed at improving joint mobility and foraminal dimensions.

10. Acupuncture
    Needle placement along meridians to stimulate endogenous analgesic mechanisms.

11. Dry Needling
    Targeting myofascial trigger points in neck and shoulder muscles to relieve spasm.

12. Massage Therapy
    Soft tissue mobilization to decrease muscle tension and improve local circulation.

13. Myofascial Release
    Hands-on technique to stretch and release fascial restrictions around the cervical spine.

14. Postural Training
    Ergonomic adjustments and exercises to maintain proper cervical alignment during daily activities.

15. Yoga and Pilates
    Gentle stretching, strengthening, and breathing techniques to support spinal health.

16. Pilates Neck Stabilization
    Focused exercises to enhance deep cervical flexor and extensor control.

17. Alexander Technique
    Re-education of movement patterns to reduce harmful neck postures.

18. Proprioceptive Neuromuscular Facilitation (PNF)
    Assisted stretching techniques to improve joint range and neuromuscular control.

19. Cognitive-Behavioral Therapy (CBT)
    Strategies to manage pain perception, stress, and coping behaviors.

20. Biofeedback
    Use of real-time monitoring of muscle activity to teach relaxation for spastic neck musculature.

21. Tai Chi
    Low-impact martial art that emphasizes slow, controlled movements and balance.

22. Ergonomic Workstation Setup
    Adjusting monitor height, chair support, and keyboard position to reduce cervical strain.

23. Aquatic Therapy
    Neck exercises performed in water to reduce load and facilitate gentle movement.

24. Neural Gliding Exercises
    Gentle mobilization of the nerve root through specific arm and neck positions to decrease adherence.

25. Cervical Pillow Support
    Specialized pillows to maintain neutral cervical alignment during sleep.

26. Position-Change Protocols
    Scheduled reminders to change head and neck positions throughout the day.

27. Cervical Roll Exercises
    Movements using a rolled towel under the neck to support curvature and relieve pressure.

28. Isometric Neck Strengthening
    Static holds against resistance to build deep neck muscle stability.

29. Scapular Stabilization Exercises
    Strengthening shoulder girdle to offload cervical musculature.

30. Mindfulness Meditation
    Stress reduction techniques that can reduce muscle tension and downstream pain.

Non-pharmacological strategies recommended by the American Family Physician and physiotherapy protocols AAFPVerywell Health.

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 Pharmacological Treatments

When conservative measures are insufficient, medications may be used to manage pain and inflammation:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
   Ibuprofen, naproxen, or diclofenac to reduce pain and peri-root inflammation.

2. Acetaminophen
   Analgesic for mild to moderate pain without anti-inflammatory effects.

3. Oral Corticosteroids
   Short courses of prednisone to decrease severe nerve root inflammation.

4. Muscle Relaxants
   Cyclobenzaprine or tizanidine to alleviate painful muscle spasms.

5. Neuropathic Pain Agents
   Gabapentin or pregabalin to modulate aberrant nerve firing.

6. Tricyclic Antidepressants
   Amitriptyline for its off-label analgesic benefits in chronic neuropathic pain.

7. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
   Duloxetine to treat both depression and neuropathic pain components.

8. Oral Opioids
   Short-term tramadol or hydrocodone for severe refractory pain under close supervision.

9. Topical NSAIDs
   Diclofenac gel applied locally over painful regions for targeted relief.

10. Capsaicin Cream
    Low-concentration topical for reduction of peripheral nerve-mediated pain.

11. Lidocaine Patches
    Transdermal patches to numb the skin overlying the painful root distribution.

12. Oral Steroid Packs
    Tapered prednisone pack to quickly reduce acute inflammation.

13. Corticosteroid Injections
    Epidural or transforaminal steroid injections directly around the affected root.

14. Calcitonin
    Intranasal or injectable formulations for acute nerve pain relief in certain cases.

15. Bisphosphonates
    When osteoporotic vertebral changes contribute to foraminal narrowing.

16. Vitamin B Complex
    B1, B6, and B12 supplements to support nerve health and repair.

17. Alpha-Lipoic Acid
    Antioxidant supplement that may benefit neuropathic symptoms.

18. Magnesium Supplements
    For muscle relaxation and potential reduction of neuropathic pain.

19. Acetyl-L-Carnitine
    Nutraceutical shown to help regenerate nerve fibers in some neuropathic conditions.

20. Cannabinoids
    Under controlled settings, medical cannabis or CBD oil for refractory neuropathic pain.

Drug recommendations aligned with pain management guidelines from the American Academy of Family Physicians AAFP.

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Surgical Interventions

When conservative and medical treatments fail or if neurological deficits progress, surgery may be indicated:

1. Anterior Cervical Discectomy (ACD)
   Removal of the herniated C5–C6 disc via a front‐of‐neck approach.

2. Anterior Cervical Discectomy with Fusion (ACDF)
   ACD followed by placement of a bone graft or cage to stabilize the segment.

3. Cervical Disc Arthroplasty
   Replacement of the disc with an artificial implant to preserve motion.

4. Posterior Cervical Laminoforaminotomy
   Removal of a portion of the lamina and facet to decompress the foraminal canal from the back.

5. Microscopic Endoscopic Foraminotomy
   Minimally invasive posterior approach using an endoscope to enlarge the foramen.

6. Corpectomy
   Removal of a vertebral body and adjacent discs, often with strut grafting to decompress multiple levels.

7. Posterior Cervical Fusion
   Lateral mass or pedicle screw fixation following decompression for multilevel disease.

8. Total Disc Replacement
   Implantation of a prosthetic disc device for multi‐segment preservation of motion.

9. Hybrid Constructs
   Combination of fusion at one level and arthroplasty at another to balance motion and stability.

10. Laser‐Assisted Discectomy
    Percutaneous laser ablation of disc material for selective decompression.

Surgical options chosen based on patient age, symptom severity, and alignment considerations Verywell Health.

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Prevention Strategies

Reducing the risk of C5–C6 nerve root compression involves lifestyle and ergonomic measures:

1. Maintain Good Posture
   Neutral head position during sitting and standing to reduce foraminal stress.

2. Ergonomic Workstation Setup
   Proper monitor height, chair support, and keyboard placement.

3. Regular Neck Exercises
   Strengthening and stretching to maintain cervical flexibility and support.

4. Avoid Heavy Overhead Lifting
   Use proper lifting techniques and keep loads close to the body.

5. Healthy Weight Maintenance
   Reduces mechanical load on cervical spine structures.

6. Quit Smoking
   Smoking impairs disc nutrition and accelerates degenerative changes.

7. Stay Hydrated
   Good disc hydration depends on adequate fluid intake.

8. Frequent Position Changes
   Avoid sustained neck postures by taking regular movement breaks.

9. Supportive Sleep Surface
   Use a pillow that maintains cervical lordosis.

10. Prompt Treatment of Neck Injuries
    Early management of strains or sprains to prevent chronic changes.

Preventive recommendations from orthopedic best-practice guidelines AAFP.

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When to See a Doctor

Seek professional evaluation if you experience:

• Severe or worsening arm weakness or numbness.

• Loss of bladder or bowel control (rare emergency sign).

• Neck pain unrelieved by rest and conservative care.

• Progressive sensory changes or atrophy in the arm or hand.

• Failure to improve after 4–6 weeks of conservative treatment.

Early assessment allows timely imaging, diagnosis, and treatment to prevent permanent nerve damage.

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Frequently Asked Questions (FAQs)

1. What exactly causes the “pinched nerve” at C5–C6?
   A combination of disc bulges, bone spurs, or ligament thickening narrows the foramen where the C6 root exits, pressing on the nerve.

2. Is nerve compression at C5–C6 the same as a herniated disc?
   Not always; while herniated discs are a common cause, osteophytes and other structures can also compress the nerve root.

3. Can this condition heal on its own?
   Many mild cases improve with rest, physical therapy, and anti-inflammatory measures over 6–12 weeks.

4. What exercises help relieve symptoms?
   Cervical traction, neural gliding, and deep neck flexor strengthening are particularly beneficial under professional guidance.

5. Are steroid injections safe?
   Epidural steroid injections are generally safe when done by an experienced clinician, though repeated injections carry cumulative risks.

6. How long does recovery take after surgery?
   Most patients resume daily activities within 4–6 weeks post-ACDF; full recovery may take 3–6 months depending on procedure and rehabilitation.

7. Will I need a fusion if I have surgery?
   Fusion stabilizes the segment but sacrifices motion; alternatives like disc arthroplasty preserve motion in select patients.

8. Can this condition cause permanent weakness?
   If compression persists untreated, irreversible nerve damage and muscle atrophy can occur. Early treatment minimizes this risk.

9. Is physical therapy always necessary?
   Yes—targeted therapy reduces pain, corrects posture, and strengthens support musculature, improving long-term outcomes.

10. Are there lifestyle changes that speed recovery?
    Smoking cessation, weight management, ergonomic adjustments, and regular gentle exercise all support healing.

11. Can children get C5–C6 nerve root compression?
    It is rare in children; when present, it is often due to congenital anomalies or acute trauma rather than degeneration.

12. What’s the difference between central and foraminal compression?
    Central compression affects the spinal cord itself, whereas foraminal compression involves the exiting nerve root only.

13. How do doctors confirm the exact level of compression?
    MRI combined with electrodiagnostic testing (EMG/NCS) localizes which root and level are affected.

14. Can chiropractic adjustments help?
    Gentle, targeted manipulations may relieve pressure on the nerve root but should be performed by a practitioner experienced in cervical conditions.

15. When is surgery unavoidable?
    Progressive neurological deficits, severe uncontrolled pain, or failure of comprehensive conservative management typically prompt surgical intervention.

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 04, 2025.

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