Cervical disk herniation: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Neck/shoulder/arm pain in [[Spinal cord levels|dermatome]] distribution, weakness, | *Neck/shoulder/arm pain in [[Spinal cord levels|dermatome]] distribution, weakness, hyporeflexia | ||
*Spurling test | |||
**Flex neck forward flexed, ipsilaterally rotate, and ipsilaterally tilt | |||
**Reproduction of radicular symptoms is positive test | |||
**Specific for nerve root compression | |||
{| class="wikitable" style="text-align:center" | {| class="wikitable" style="text-align:center" | ||
! Radiculopathy | ! Radiculopathy | ||
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||Index/Middle distal phlnx flexion||Small Finger Paresthesia|| | ||Index/Middle distal phlnx flexion||Small Finger Paresthesia|| | ||
|} | |} | ||
*[[Eponyms_(F-L)#Lhermitte's sign]] positive suggests cord compression from midline herniation | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Workup== | ==Workup== | ||
*MRI required for definitive diagnosis | *MRI required for definitive diagnosis | ||
Revision as of 21:10, 27 May 2017
Background
- Nucleus pulposus protrudes through posterior annular fibrosis
- Leads to radiculopathy or less commonly myelopathy
Clinical Features
- Neck/shoulder/arm pain in dermatome distribution, weakness, hyporeflexia
- Spurling test
- Flex neck forward flexed, ipsilaterally rotate, and ipsilaterally tilt
- Reproduction of radicular symptoms is positive test
- Specific for nerve root compression
| Radiculopathy | Motor Deficit | Sensory Deficit | Diminished Reflex |
|---|---|---|---|
| C4 | Levator Scapulae & Shoulder elevation | ||
| C5 | Deltoid & Biceps | Biceps | |
| C6 | Brachioradialis & Wrist extension | Thumb Paresthesia | Brachioradialis |
| C7 | Triceps & Wrist flexion | Index/Middle/Ring Paresthesia | Triceps |
| C8 | Index/Middle distal phlnx flexion | Small Finger Paresthesia |
- Eponyms_(F-L)#Lhermitte's sign positive suggests cord compression from midline herniation
Differential Diagnosis
Neck pain
- Musculoskeletal
- Torticollis
- Dystonic reaction
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- Cervical fractures and dislocations
- Cervical radiculopathy
Workup
- MRI required for definitive diagnosis