Cervical radiculopathy
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
- Spurling sign - closes the neural foramens
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
- Lateral disc herniation
- brachial plexitis, Brachial plexus injury
- Shoulder pathology
- Entrapment neuropathy
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
- Cervical xray
Management
- Primary treatment typically utilizes NSAIDS
- 6 weeks of nonsurgical treatment with pain control
- May consider steroids, gabapentin, nortriptyline, SNRIs (e.g. venlafaxine, duloxetine) and muscle relaxers (e.g. cyclobenzaprine)
- 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 physical therapy 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
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