Cervical radiculopathy

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

• lateral disc herniation
• brachial plexitis, Brachial plexus injury
• shoulder pathology
  • adhesive capsulitis
  • recurrent anterior subluxation
  • impingement syndrome
• entrapment neuropathy
  • Carpal tunnel syndrome
  • Thoracic outlet syndrome

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

External Links

• http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/