Cervical Radiculopathy Flashcards
Hx
62 yr old F 2 wk Hx of L arm pain that starts at the shoulder and runs down the arm to the fingertips, intermittent tingling sensation in L hand and some clumsiness.
L handed. Severe headaches, a/w neck pain. Background of well controlled asthma.
look/inspection
cervical postures
previous scars
Active movement
limited active ROM of cervical spine
Passive and resisted movement
not expected
special tests - Lhermitte sign
sensation of electrical shock on neck flexion
cervical compression test laterally flex the head and apply downward pressure on it. Positive sign = ipsilateral pain of neck/ shoulder
Other exams
Upper limb neuro exam
reduced power L finger extension
Reduced sensation L middle finger
L triceps jerk
DDx
Cervical radiculopathy
Cervical spondylois
Brachial plexus injury
Rotator cuff injury
Why is cervical radiculopathy likely?
Shooting pain shooting down the arm
Pain arises above the shoulder + down to the fingers
Positive neuro findings w/ absent L triceps jerk C7,C8
Weak finger extension C7 myotome
Reduced sensation to L middle finger C7 nerve root
reduced ROM at cervical spine
Causes of cervical radiculopathy
herniated cervical vertebral disc
osteophyte formation from facet joint degenerative changes impinging on the nerve root
Why is cervical spondylosis unlikely
degenerative disorder can encroach on cervical spinr giving neuro symptoms, use MRI to ddx
Why is brachial plexus injury unlikely
No Hx of trauma
No signs of muscle wasting/ deformity of L upper limb
Why is rotator cuff pathology unlikely
would expect pain on resisted movements of glenohumeral joint
Investigations
X-ray
MRI cervical spine
CT
CT myelography
X-ray
AP Lateral Oblique views of cervical spine w/ flexion and extension views if there is suspicion for instability
degenerative changes of facet joints
osteophyte formation
disc space narrowing and endplate sclerosis
assess alignment and spinal canal diameter
Foraminal stenosis caused by osteophytes
MRI cervical spine
T2
Disc degeneration & herniation
foraminal stenosis w/ nerve root compression [loss of perineural fat]
central compression w/ CSF effacement
