Cervical radiculopathy

Cervical radiculopathy describes a condition in which impingement/irritation of the cervical nerve roots causes symptoms in the neck/upper limb. 

The classical presentation is arm/neck

• Pain 
• Weakness 
• Numbness

If C7 is affected there may be scapula winging. 

Causes of cervical radiculopathy include 

• Disc herniation 
• Bony degeneration 

Diagnosis 

• Clinical impression/provocation tests 
• Upper limb tension test – high sensitivity 
• Spurling’s test or shoulder abduction test– high specificity 
• Electromyographical studies 
• Imaging – MRI, CT myelography 

Management 

• Analgesia 
• Note that for most patients signs and symptoms will resolve spontaneously over time without treatment 
• ? TCA 
• ? epidural steroid injection 
• ? surgical decompression 

References

Eubanks, J. Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. Am Fam Physician. 2010; 81(1): 33-40. 

Makin, G., Brown, W. and Ebers, G. C7 radiculopathy: importance of scapula winging in clinical diagnosis. J Neurol Neurosurg Psychiatry. 1986; 49(6): 640-644. 

North American Spine Society. Diagnosis and treatment of cervical radiculopathy from degenerative disorders. 2010. Available at www.spine.org/Documents/Cervical_Radiculopathy.pdf 

Rubinstein, S. et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Spine. 2007; 16(3): 307-319.

 

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