Cervical radiculopathy: Difference between revisions
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*Compression and inflammation of the spinal nerve | *Compression and inflammation of the spinal nerve | ||
*Most commonly affects C5-C6 or C6-C7 | *Most commonly affects C5-C6 or C6-C7 | ||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*lateral disc herniation | *lateral disc herniation | ||
*brachial plexitis | *brachial plexitis | ||
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**carpal tunnel syndrome | **carpal tunnel syndrome | ||
**thoracic oulet syndrome | **thoracic oulet syndrome | ||
==Evaluation== | ==Evaluation== | ||
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**Cervical xray | **Cervical xray | ||
***can be obtained to exclude frank instability | ***can be obtained to exclude frank instability | ||
**MRI | **MRI | ||
***Performed nonurgenly | ***Performed nonurgenly | ||
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==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf | *http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf | ||
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/ | |||
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/ | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
Revision as of 05:00, 13 July 2017
Background
- neck pain radiating to the upper extremities
- can have associated weakness or numbness
- Compression and inflammation of the spinal nerve
- Most commonly affects C5-C6 or C6-C7
Clinical Features
- Follows a dermatome or myotome distribution
- Diminished muscle tendon reflexes
- Sensory changes
- Motor weakness
- If C6 is affected: diminished brachioradialis reflex, bicep muscle weakness, paresthesias in the arms to the thumb/index finger
- If C7 is affected: diminished triceps reflex, tricep muscle weakness, paresthesias radiating in the arms to the middle finger
- Spurling sign- closes the neural foramens so if pain is worse w/ lateral bending tothe painful arm--> radiculopathy; if pain is worsen when bending to the contralateral arm--> nonspecific soft tissue injury
- Pt looks straight ahead and attempts to touch the ear to the shoulder
- Spurling sign- closes the neural foramens so if pain is worse w/ lateral bending tothe painful arm--> radiculopathy; if pain is worsen when bending to the contralateral arm--> nonspecific soft tissue injury
Differential Diagnosis
- lateral disc herniation
- brachial plexitis
- shoulder pathology
- adhesive capsulitis
- recurrent anterior subluxation
- impingement syndrome
- entrapment neuropathy
- carpal tunnel syndrome
- thoracic oulet syndrome
Evaluation
- Full neuro exam
- motor weakness --> early surgical referral
- Imaging
- Cervical xray
- can be obtained to exclude frank instability
- MRI
- Performed nonurgenly
- spondylararthrosis
- Herniated disc
- Cervical xray
Management
- NSAIDS
- 6 weeks of nonsurgical treatment w/ pain control
- Recent studies show no benefit for physiotherapy versus cervical collar
- Study comparing semi-hard cervical collar w/ as much rest as possible versus physiotherapy and at home exercise compared to wait and see
- In patients with acute cervical radiculopathy symptoms, a semi hard collar w/ as much rest as needed and physiotherapy w/ at home exercise program over 6 weeks reduced pain compared to wait and see policy
Disposition
- Outpatient follow up with primary care/orthopedics
- Majority of patients approx 75% in one study reported pain relief in 4 weeks
- pain control with NSAIDS
See Also
External Links
- http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/