cervical radiculopathy
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Etiology
- cervical spondylosis
- facet joint osteoarthritis
- age-related vertebral disc disease
Epidemiology
- primarily affects middle-aged & older adults
- more frequent in men than women
Pathology
- cervical nerve root compression & inflammation, most commonly C7 radiculopathy > C6 radiculopathy > C8 & C2 radiculopathy
- cervical nerve compression may be acute due to herniated disk
- or chronic due to hypertrophied facet joints[6]
Physical examination
Clinical manifestations
- sensory symptoms in the territory of the affected nerves
- paresthesia, numbness
- index & middle fingers may be involved
- paresthesia, numbness
- neck pain
- pain radiating from the shoulder or upper back to the proximal arm
- painful neck spasms may occur[6]
- range of motion of neck may be compromised
- most cases are unilateral, but bilateral pain can occur with central disc herniation or with large spinal osteophytes[9]
- weakness in muscles innervated by affected nerves in advanced cases
- reflexes may be lost
Diagnostic procedures
- electromyography &/or nerve conduction study to localize the specific area of nerve compression for:
- poorly defined radiculopathy
- consideration of surgery
Radiology
- magnetic resonance imaging or CT myelography for:
- acute trauma
- weakness, hyporeflexia
- sign/symptoms of spinal cord involvement
Differential diagnosis
- myelopathy suggested by neurologic signs/symptoms at & below the affected area of the spinal cord
- thoracic outlet syndrome
Management
- analgesics: NSAIDs, acetaminophen
- avoidance of exacerbating activities
- neck exercises treatment of choice[1]
- most patients have resolution with 2-3 months[1]
- cervical collar, cervical pillow
- mostly for patient satisfaction
- avoid especially for > 1-2 weeks[1]
- referral to surgery for progressive motor deficits[1]
- epidural steroid injections no better than conservative management[5]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
- ↑ Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28;353(4):392-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16049211
- ↑ Nikolaidis I, Fouyas IP, Sandercock PA, Statham PF. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001466 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20091520
- ↑ Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009 Oct 7;339:b3883 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19812130
- ↑ 5.0 5.1 Cohen SP et al. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study. Anesthesiology 2014 Nov; 121:1045 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25335172
- ↑ 6.0 6.1 6.2 Rothaus C Cervical Spondylosis NEJM Resident 360. July 8, 2020 https://resident360.nejm.org/clinical-pearls/cervical-spondylosis
- ↑ Corey DL, Comeau D. Cervical radiculopathy. Med Clin North Am 2014 Jul; 98:791 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24994052
- ↑ North American Spine Society. Evidence-based clinical guidelines for multidisciplinary spine care: diagnosis and treatment of cervical radiculopathy from degenerative disorders. 2010. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/CervicalRadiculopathy.pdf
- ↑ 9.0 9.1 9.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Rainville J, Joyce AA, Laxer E et al. Comparison of symptoms from C6 and C7 radiculopathy. Spine. 2017;42(20):1545-1551 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28767636 https://journals.lww.com/spinejournal/Abstract/2017/10150/Comparison_of_Symptoms_From_C6_and_C7.9.aspx