Cervical radiculopathy

Background

• 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 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
    • Pt looks straight ahead and attempts to touch the ear to the shoulder

Differential Diagnosis

• lateral disc herniation
• brachial plexitis
• shoulder pathology
  • adhesive capsulitis
  • recurrent anterior subluxation
  • impingement syndrome
• entrapment neuropathy
  • carpal tunnel syndrome
  • thoracic oulet syndrome

Evaluation

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

Management

• • NSAIDS
• 6 weeks of nonsurgical treatment with pain control
  • Recent studies show no benefit for physiotherapy versus cervical collar
• Study comparing semi-hard cervical collar with as much rest as possible versus physiotherapy and at home exercise compared to wait and see
  • 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

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/