Difference between revisions of "Cervical radiculopathy"

(Created page with "==Background== *neck pain radiating to the upper extremities **can have associated weakness or numbness *Compression and inflammation of the spinal nerve *Most commonly affec...")
 
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*Compression and inflammation of the spinal nerve  
 
*Compression and inflammation of the spinal nerve  
 
*Most commonly affects C5-C6 or C6-C7
 
*Most commonly affects C5-C6 or C6-C7
 
  
 
==Clinical Features==
 
==Clinical Features==
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==Differential Diagnosis==
 
==Differential Diagnosis==
 
 
*lateral disc herniation  
 
*lateral disc herniation  
 
*brachial plexitis  
 
*brachial plexitis  
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**carpal tunnel syndrome  
 
**carpal tunnel syndrome  
 
**thoracic oulet syndrome
 
**thoracic oulet syndrome
 
  
 
==Evaluation==
 
==Evaluation==
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**Cervical xray
 
**Cervical xray
 
***can be obtained to exclude frank instability
 
***can be obtained to exclude frank instability
 
 
**MRI  
 
**MRI  
 
***Performed nonurgenly
 
***Performed nonurgenly
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==See Also==
 
==See Also==
 +
  
 
==External Links==
 
==External Links==
http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf
+
*http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf
 
+
*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/
 
  
 
==References==
 
==References==
 
<references/>
 
<references/>
 +
 +
[[Category:Orthopedics]]

Revision as of 05:00, 13 July 2017

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 w/ 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 w/ pain control
    • Recent studies show no benefit for physiotherapy versus cervical collar
  • Study comparing semi-hard cervical collar w/ 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 w/ as much rest as needed and physiotherapy w/ 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

See Also

External Links

References