Cervical disk herniation: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Neck/shoulder/arm pain in [[Spinal cord levels|dermatome]] distribution, weakness, hyporeflexia | *Neck/shoulder/arm pain in [[Spinal cord levels|dermatome]] distribution, weakness, hyporeflexia | ||
*Spurling test | *Spurling test | ||
**Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt | **Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt | ||
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*[[Eponyms_(F-L)#Lhermitte's sign|Lhermitte's sign]] positive suggests cord compression from midline herniation | *[[Eponyms_(F-L)#Lhermitte's sign|Lhermitte's sign]] positive suggests cord compression from midline herniation | ||
*Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology | *Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology | ||
{{Cervical radiculopathy table}} | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Latest revision as of 00:50, 5 June 2017
Background
- Nucleus pulposus protrudes through posterior annular fibrosis
- Leads to radiculopathy or less commonly myelopathy
Clinical Features
- Neck/shoulder/arm pain in dermatome distribution, weakness, hyporeflexia
- Spurling test
- Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt
- Reproduction of radicular symptoms is positive test
- Specific for nerve root compression
- Lhermitte's sign positive suggests cord compression from midline herniation
- Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology
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
Neck pain
- Musculoskeletal
- Torticollis
- Dystonic reaction
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- Cervical fractures and dislocations
- Cervical radiculopathy
Evaluation
- MRI required for definitive diagnosis; indicated if neurologic signs
Management
Disposition
- In consultation with Neurosurg, admit if progression of neurologic signs