Cervical radiculopathy: Difference between revisions
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*If C7 is affected: diminished triceps reflex, tricep muscle weakness, paresthesias radiating in the arms to the middle 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 | **Spurling sign - closes the neural foramens | ||
***if pain is worse with lateral bending to the painful | ***if pain is worse with lateral bending to the painful arm→ radiculopathy | ||
***if pain is worsen when bending to the contralateral | ***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 | **Patient looks straight ahead and attempts to touch the ear to the shoulder | ||
===[[Spinal cord levels|Cervical Exam by Level]]=== | ===[[Spinal cord levels|Cervical Exam by Level]]=== | ||
Line 48: | Line 48: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* | *Lateral disc herniation | ||
*brachial plexitis, [[Brachial plexus injury]] | *brachial plexitis, [[Brachial plexus injury]] | ||
* | *[[Shoulder and upper arm diagnoses|Shoulder pathology]] | ||
** | **[[Adhesive capsulitis]] | ||
** | **Recurrent [[Anterior shoulder dislocation|anterior subluxation]] | ||
** | **[[Impingement syndrome]] | ||
* | *Entrapment neuropathy | ||
**[[Carpal tunnel syndrome]] | **[[Carpal tunnel syndrome]] | ||
**[[Thoracic outlet syndrome]] | **[[Thoracic outlet syndrome]] | ||
==Evaluation== | ==Evaluation== | ||
*Full neuro exam | *Full [[neuro exam]] | ||
**motor weakness | **motor weakness → early surgical referral | ||
*Imaging | *Imaging | ||
**Cervical xray | **Cervical xray | ||
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==Management== | ==Management== | ||
*Primary treatment typically utilizes NSAIDS | *Primary treatment typically utilizes [[NSAIDS]] | ||
**6 weeks of nonsurgical treatment with pain control | **6 weeks of nonsurgical treatment with pain control | ||
**May consider steroids, gabapentin, nortriptyline, | **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 | *Short term immobilization and rest may calm symptoms of CR | ||
**Recent literature review showed that exercise is beneficial for improving function and activity levels | **Recent literature review showed that exercise is beneficial for improving function and activity levels | ||
**Outpatient | **Outpatient physical therapy evaluation may be beneficial but home exercises should be recommended to patients in the interim | ||
==Disposition== | ==Disposition== |
Revision as of 14:45, 17 November 2017
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
- http://www.bmj.com/content/bmj/339/bmj.b3883.full.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116771/