Cervical radiculopathy: Difference between revisions

Revision as of 14:45, 17 November 2017

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

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
- Patient looks straight ahead and attempts to touch the ear to the shoulder

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

Primary treatment typically utilizes NSAIDS
- 6 weeks of nonsurgical treatment with pain control
- May consider steroids, gabapentin, nortriptyline, SNRIs (e.g. venlafaxine, duloxetine) and muscle relaxers (e.g. cyclobenzaprine)
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 physical therapy evaluation may be beneficial but home exercises should be recommended to patients in the interim

Authors:

@@ Line 21: / Line 21: @@
 *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 worse with lateral bending to the painful arm→ radiculopathy
-***if pain is worsen when bending to the contralateral arm--> nonspecific soft tissue injury
+***if pain is worsen when bending to the contralateral arm→ nonspecific soft tissue injury
 **Patient looks straight ahead and attempts to touch the ear to the shoulder
 ===[[Spinal cord levels|Cervical Exam by Level]]===
@@ Line 60: / Line 60: @@
 ==Evaluation==
 *Full [[neuro exam]]
-**motor weakness --> early surgical referral
+**motor weakness → early surgical referral
 *Imaging
 **Cervical xray