Cervical radiculopathy: Difference between revisions

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==Background==
==Background==
*neck pain radiating to the upper extremities
*Cervical radiculopathy (CR) is commonly seen in the ED
**Incidence of 107.3/100,000 men and 63.5/100,000 women
**Peak incidence at age 50-54
*Risk factors
**White race
**female gender
**cigarette smoking
**prior lumbar radiculopathy
*Neck pain radiating to the upper extremities
**can have associated weakness or numbness
**can have associated weakness or numbness
*Compression and inflammation of the spinal nerve  
*Compression and inflammation of the spinal nerve  
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*If C6 is affected: diminished brachioradialis reflex, bicep muscle weakness, paresthesias in the arms to the thumb/index finger
*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  
*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 with lateral bending tothe painful arm--> radiculopathy; if pain is worsen when bending to the contralateral arm--> nonspecific soft tissue injury
**Spurling sign - closes the neural foramens
***Pt looks straight ahead and attempts to touch the ear to the shoulder
***if pain is worse with lateral bending to the 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


==Differential Diagnosis==
==Differential Diagnosis==
*lateral disc herniation  
*lateral disc herniation  
*brachial plexitis  
*brachial plexitis, [[Brachial plexus injury]]
*shoulder pathology  
*shoulder pathology  
**adhesive capsulitis  
**adhesive capsulitis  
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**impingement syndrome  
**impingement syndrome  
*entrapment neuropathy  
*entrapment neuropathy  
**carpal tunnel syndrome  
**[[Carpal tunnel syndrome]]
**thoracic oulet syndrome
**[[Thoracic outlet syndrome]]


==Evaluation==
==Evaluation==
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***can be obtained to exclude frank instability
***can be obtained to exclude frank instability
**MRI  
**MRI  
***Performed nonurgenly
***Performed non-urgently
***spondylararthrosis
***spondylararthrosis
***Herniated disc
***Herniated disc


==Management==
==Management==
**NSAIDS  
*Primary treatment typically utilizes NSAIDS  
*6 weeks of nonsurgical treatment with pain control
**6 weeks of nonsurgical treatment with pain control
**Recent studies show no benefit for physiotherapy versus cervical collar
**May consider steroids, gabapentin, nortriptyline, SNRI's, and muscle relaxers
*Study comparing semi-hard cervical collar with as much rest as possible versus physiotherapy and at home exercise compared to wait and see
*Short term immobilization and rest may calm symptoms of CR
**In patients with acute cervical radiculopathy symptoms, a semi hard collar with as much rest as needed and physiotherapy with at home exercise program over 6 weeks reduced pain compared to wait and see policy
**Recent literature review showed that exercise is beneficial for improving function and activity levels
**Outpatient PT evaluation may be beneficial but home exercises should be recommended to patients in the interim


==Disposition==
==Disposition==

Revision as of 17:12, 7 August 2017

Background

  • Cervical radiculopathy (CR) is commonly seen in the ED
    • Incidence of 107.3/100,000 men and 63.5/100,000 women
    • Peak incidence at age 50-54
  • Risk factors
    • White race
    • female gender
    • cigarette smoking
    • prior lumbar radiculopathy
  • 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
      • if pain is worse with lateral bending to the 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

Differential Diagnosis

Evaluation

  • Full neuro exam
    • motor weakness --> early surgical referral
  • Imaging
    • Cervical xray
      • can be obtained to exclude frank instability
    • MRI
      • Performed non-urgently
      • spondylararthrosis
      • Herniated disc

Management

  • Primary treatment typically utilizes NSAIDS
    • 6 weeks of nonsurgical treatment with pain control
    • May consider steroids, gabapentin, nortriptyline, SNRI's, and muscle relaxers
  • Short term immobilization and rest may calm symptoms of CR
    • Recent literature review showed that exercise is beneficial for improving function and activity levels
    • Outpatient PT evaluation may be beneficial but home exercises should be recommended to patients in the interim

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

References

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