Difference between revisions of "Cervical radiculopathy"

(Background)
(Clinical Features)
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==Clinical Features==
 
==Clinical Features==
*Follows a dermatome or myotome distribution
+
*Follows a [[dermatome]] or myotome distribution
 
**Diminished muscle tendon reflexes
 
**Diminished muscle tendon reflexes
 
**Sensory changes
 
**Sensory changes
**Motor weakness
+
**Motor [[weakness]]
 
*If C6 is affected: diminished brachioradialis reflex, bicep muscle weakness, paresthesias in the arms to the thumb/index finger
 
*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  
 
*If C7 is affected: diminished triceps reflex, tricep muscle weakness, paresthesias radiating in the arms to the middle finger  
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***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
**Pt looks straight ahead and attempts to touch the ear to the shoulder
+
**Patient looks straight ahead and attempts to touch the ear to the shoulder
 +
===[[Spinal cord levels|Cervical Exam by Level]]===
 +
{|  class="wikitable"  style="text-align:center"
 +
! 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||
 +
|}
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

Revision as of 19:25, 11 August 2017

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

Cervical Exam by Level

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

Differential Diagnosis

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

See Also

External Links

References