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

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

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

Management

  • Primary treatment typically utilizes NSAIDS
  • 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