Cervical radiculopathy

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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

See Also

External Links

References