Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Cervical Radiculopathy

- See:
      - Brachial Plexus - Neuro Exam
      - Diff Dx of Cervical Pathology:
      - Neuro Exam:
      - PE of the C-spine:
      - PE of Lumbar Spine:

- Discussion:
     - can be associated with myelopathy;
     - can involve one or multiple roots, and symptoms include neck, shoulder, and arm pain, paresthesias, and numbness;
     - findings may overlap because of intraneural intersegmental connections of sensory nerve roots;
     - lower nerve root at a given level is usually affected;

- Examination of the Cervical Spine:
     - Spurling's Manuever:
             - mechanical stress, such as excessive vertebral motion, may exacerbate symptoms;
             - the provocation of the patient's arm pain with induced narrowing of the neuroforamen
             - gentle neck hyperextension with the head tilted toward the affected side will narrow the size of the neuroforamin and may exacerbate
                      the symptoms or produce radiculopathy;
                      - ipsilateral rotation of the neck will also increase radiculopathy;
             - downward head compression increases the patient's radicular pain and paresthesias, especially if the neck is flexed to the side of involvment;
     - Shoulder Abduction Relief Test:
             - significant relief of arm pain with shoulder abduction;
             - this sign is more likely to be present w/ soft disc herniation, whereas, the test is likely to be negative with radiculopathy caused
                      by spondylosis (osteophyte compression);
     - Tinel's Sign:
             - in radiculopathy, direct palpation or percussion over the exiting nerve root may provoke the patient's familiar limb or axial pain;
             - if the tenderness or a Tinel's sign is elicited more laterally, such as in the supraclavicular fossa, then the diagnosis should be questioned;

- Surgical Treatment: (see spondylosis)
    - in the study by Sampath P, et al (1999), while 75% of patients had a satisfactory outcome, 25% continued to have persistent
           excruciating or horrible pain

The shoulder abduction test in the diagnosis of radicular pain in cervical extradural compressive monoradiculopathies.

Outcome in patients with cervical radiculopathy. Prospective multicenter study with independent clinical review.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:13 pm

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