Cervical Radiculopathy
Pathology
Unlike the lumbar spine the cervical spine has cervical nerve roots that exit above the level of the corresponding pedicle. A radiculopathy is a pathologic process affecting the nerve root and can be divided into compressive and noncompressive etiologies. The majority of radiculopathies involve the compression of the exiting nerve root. Compression can happen by the two most common mechanisms of herniated disk material or cervical spondylosis.
Epidemiology
Patients experiencing acute and chronic neck pain should be evaluated for cervical radiculopathy because it is a common cause. The mean age of individuals with cervical radiculopathy is 47.9 years old and more commonly seen in men. Usually lower cervical roots are more frequently affected, mostly C7 and then C6 being the second most common nerve root.
Clinical Presentation
The patient will present with neck pain and radiating arm pain or numbness in the distribution of a specific nerve root. At times the radiating pain may not be in a dermatomal pattern and the patient will only report neck, shoulder, and arm pain. Often cervical radiculopathy will also present with sensory and/or motor disturbances; therefore, it is important to perform a neurological screen. There are danger signs to be cautious of with cervical radiculopathy:
Diagnostic Evaluation
When the examiner performs the neurologic exam on a patient suspected of cervical radiculopathy the examiner must always look for signs of weakness and sensory disturbance in myotomal and dermatomal patterns. A possible feature of cervical radiculopathy is sensory loss in peripheral nerve lesions as well as reduced reflexes of C5, C6, or C7 nerve roots.
A special test which is performed to rule in or rule out cervical radiculopathy is the Spurling’s Test. Please see the Spurling’s Test under the ‘Special Test’ tab for a description and video demonstration.
If the patient’s symptoms do not resolve within 4-6 weeks of conservative therapy then imaging may need to be done.
Unlike the lumbar spine the cervical spine has cervical nerve roots that exit above the level of the corresponding pedicle. A radiculopathy is a pathologic process affecting the nerve root and can be divided into compressive and noncompressive etiologies. The majority of radiculopathies involve the compression of the exiting nerve root. Compression can happen by the two most common mechanisms of herniated disk material or cervical spondylosis.
Epidemiology
Patients experiencing acute and chronic neck pain should be evaluated for cervical radiculopathy because it is a common cause. The mean age of individuals with cervical radiculopathy is 47.9 years old and more commonly seen in men. Usually lower cervical roots are more frequently affected, mostly C7 and then C6 being the second most common nerve root.
Clinical Presentation
The patient will present with neck pain and radiating arm pain or numbness in the distribution of a specific nerve root. At times the radiating pain may not be in a dermatomal pattern and the patient will only report neck, shoulder, and arm pain. Often cervical radiculopathy will also present with sensory and/or motor disturbances; therefore, it is important to perform a neurological screen. There are danger signs to be cautious of with cervical radiculopathy:
- Lhermitte’s sign (shock-like paresthesia occurring with neck flexion)
- History of difficult walking
- Lower extremity or trunk symptoms
- Bowel and bladder dysfunction
- *All signs of a myelopathy and need immediate referral
Diagnostic Evaluation
When the examiner performs the neurologic exam on a patient suspected of cervical radiculopathy the examiner must always look for signs of weakness and sensory disturbance in myotomal and dermatomal patterns. A possible feature of cervical radiculopathy is sensory loss in peripheral nerve lesions as well as reduced reflexes of C5, C6, or C7 nerve roots.
A special test which is performed to rule in or rule out cervical radiculopathy is the Spurling’s Test. Please see the Spurling’s Test under the ‘Special Test’ tab for a description and video demonstration.
If the patient’s symptoms do not resolve within 4-6 weeks of conservative therapy then imaging may need to be done.
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