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cervical radiculopathy

Etiology: - cervical spondylosis - facet joint osteoarthritis - age-related vertebral disc disease Epidemiology: - primarily affects middle-aged & older adults - more frequent in men than women Pathology: - cervical nerve root compression & inflammation, most commonly C7 radiculopathy > C6 radiculopathy > C8 & C2 radiculopathy - cervical nerve compression may be acute due to herniated disk - or chronic due to hypertrophied facet joints [6] Physical examination: - Spurling test - arm squeeze test [9] Clinical manifestations: 1) sensory symptoms in the territory of the affected nerves - paresthesia, numbness - index & middle fingers may be involved 2) neck pain - pain radiating from the shoulder or upper back to the proximal arm - painful neck spasms may occur [6] - range of motion of neck may be compromised 3) most cases are unilateral, but bilateral pain can occur with central disc herniation or with large spinal osteophytes [9] 4) weakness in muscles innervated by affected nerves in advanced cases - weakness in elbow extension & wrist flexion 5) reflexes may be lost Special laboratory: - electromyography &/or nerve conduction study to localize the specific area of nerve compression for: - poorly defined radiculopathy - consideration of surgery Radiology: - magnetic resonance imaging or CT myelography for: a) acute trauma b) weakness, hyporeflexia c) sign/symptoms of spinal cord involvement Differential diagnosis: - myelopathy suggested by neurologic signs/symptoms at & below the affected area of the spinal cord - thoracic outlet syndrome Management: - analgesics: NSAIDs, acetaminophen - avoidance of exacerbating activities - neck exercises treatment of choice [1] - most patients have resolution with 2-3 months [1] - cervical collar, cervical pillow - mostly for patient satisfaction - avoid especially for > 1-2 weeks [1] - referral to surgery for progressive motor deficits [1] - epidural steroid injections no better than conservative management [5]

Related

cervical spondylosis

Specific

C5 radiculopathy C6 radiculopathy C6, C7 radiculopathy C7 radiculopathy C8 radiculopathy

General

radiculopathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
  2. Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28;353(4):392-9. PMID: 16049211
  3. Nikolaidis I, Fouyas IP, Sandercock PA, Statham PF. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001466 PMID: 20091520
  4. Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009 Oct 7;339:b3883 PMID: 19812130
  5. Cohen SP et al. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study. Anesthesiology 2014 Nov; 121:1045 PMID: 25335172
  6. Rothaus C Cervical Spondylosis NEJM Resident 360. July 8, 2020 https://resident360.nejm.org/clinical-pearls/cervical-spondylosis
  7. Corey DL, Comeau D. Cervical radiculopathy. Med Clin North Am 2014 Jul; 98:791 PMID: 24994052
  8. North American Spine Society. Evidence-based clinical guidelines for multidisciplinary spine care: diagnosis and treatment of cervical radiculopathy from degenerative disorders. 2010. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/CervicalRadiculopathy.pdf
  9. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  10. Rainville J, Joyce AA, Laxer E et al. Comparison of symptoms from C6 and C7 radiculopathy. Spine. 2017;42(20):1545-1551 PMID: 28767636 https://journals.lww.com/spinejournal/Abstract/2017/10150/Comparison_of_Symptoms_From_C6_and_C7.9.aspx