Cervical radiculopathy

Abstract

The history, pathoanatomy and pathophysiology, clinical picture, differential diagnosis, diagnostic evaluation, and treatment of cervical radiculopathy are reviewed. The review is based on a 10-year Medline literature search, review of bibliographies in textbooks, and bibliographies in articles obtained through the search. Cervical radiculopathy, although recognized early in the 20th century, was first associated with disc pathology in the mid-1930s. It is most commonly caused by disc herniation or cervical spondylosis. History and physical examination using pain location, manual muscle testing, and specialized testing (Spurling's maneuver) will usually suffice to diagnose the radiculopathy and determine the root level involved. Diagnostic imaging such as magnetic resonance imaging, computed tomography, or myelography should be used as presurgical evaluative tools or when tumor or other etiology besides disc herniation or spondylosis is suspected. Electromyography is of benefit in distinguishing various entities that clinically present similar to cervical radiculopathy and can also help to "date" the lesion. Treatment of this disorder has not been systematically studied in a controlled fashion. However, using a variety of different treatments, the radiculopathy usually improves without the need for surgery. Indications for surgery are unremitting pain despite a full trial of non-surgical management, progressive weakness, or new or progressive cervical myelopathy. Prospective studies evaluating the various treatment options would be of great benefit in guiding practitioners toward optimum cost-effective evaluation and care of the patient with cervical radiculopathy.

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

“…The diagnostic criteria are, however, unclear [7,43]. Some suggest that cervical radiculopathy is a diagnosis based upon clinical impression [5,9,23,57], which should be confirmed by advanced testing, such as diagnostic imaging [12,15,34,50], or electrophysiology studies [22,27,40]. However, clinical and radiological diagnoses, and electrophysiological testing all have inherent limitations [59].…”

Resolution of cervical radiculopathy in a woman after chiropractic manipulation

“…Less common causes include intraspinal or extraspinal tumors, nerve root avulsion secondary to trauma, meningeal or synovial cysts, arteritis, cerebral palsy, or vascular abnormalities. 12,13 It can also occur with no apparent cause. 11,13 The differential diagnoses includes idiopathic brachial plexopathy, local disorders of the shoulder, upper limb entrapment neuropathies, and, when accompanied by myelopathy, syringomyelia and motor neuron disease.…”

“…11,13 The differential diagnoses includes idiopathic brachial plexopathy, local disorders of the shoulder, upper limb entrapment neuropathies, and, when accompanied by myelopathy, syringomyelia and motor neuron disease. 13 Clinically, it most commonly presents with pain, often described as sharp, lancinating, achy, or burning, in the neck, shoulder, arm, or chest, depending on the root or roots involved, usually in a myotomal distribution. Arm pain is more common than neck pain.…”

“…Arm pain is more common than neck pain. [11][12][13] Sensory changes, such as paresthesias and numbness, are more common than loss of motor strength or reflex changes, although the sensory examination is less reliable because of dermatomal overlap 12,13 Citing multiple authors, Ellenberg et al 13 report that " Eighty to 100% of patients will present with neck and arm pain with or without motor weakness or paresthesia, generally not preceded by trauma or other determinable precipitating cause." The C7 root is most commonly affected, followed by C6.…”

“…The C7 root is most commonly affected, followed by C6. [11][12][13] After a careful history and routine neurologic assessment, clinical evaluation should note sensory loss, tone, strength, and bulk of muscles and reflexes. Provocative maneuvers may be observed that stretch the nerve root, such as coughing, sneezing, Valsalva, cervical distraction, and the Spurling maneuver.…”