Cervical radiculopathy: Difference between revisions

Revision as of 20:50, 1 February 2021

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 maneuver (neck compression test)
- With patients head extended and rotated to affected side, apply pressure to top of head
- Positive if it produces pain or parasthesias beyond the shoulder
- High specificity (0.89-1.00) with variable sensitivity (0.38-0.97)^[1]

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

↑ Thoomes EJ, van Geest S, van der Windt DA, et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. Spine J. 2018;18(1):179-189. doi:10.1016/j.spinee.2017.08.241

Authors:

@@ Line 20: / Line 20: @@
 *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
+*Spurling maneuver (neck compression test)
-***if pain is worse with lateral bending to the painful arm→ radiculopathy
+**With patients head extended and rotated to affected side, apply pressure to top of head
-***if pain is worsen when bending to the contralateral arm→ nonspecific soft tissue injury
+**Positive if it produces pain or parasthesias beyond the shoulder
-**Patient looks straight ahead and attempts to touch the ear to the shoulder
+**High specificity (0.89-1.00) with variable sensitivity (0.38-0.97)<ref>Thoomes EJ, van Geest S, van der Windt DA, et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. Spine J. 2018;18(1):179-189. doi:10.1016/j.spinee.2017.08.241</ref>
 ===[[Spinal cord levels|Cervical Exam by Level]]===
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