Diagnosis of cervical radiculopathy

diagnosis

Patient presentation and history

• the symptoms seen in radiculopathy are usually unilateral
  • bilateral symptoms are associated with arthritis of the cervical spine
• patients often describes the following symptoms:
  • pain
    • radicular pain is the most common symptom
    • neck pain may be accompanied by radiation into the ipsilateral arm in a dermatomal distribution
    • may be described as dull to severe burning pain
    • in some patients, pain may radiate to the posterior shoulder and periscapular region
    • neck extension or lateral flexion to the affected side may worsen the symptoms
    • absence of pain in the arm does not exclude the possibility of cervical radiculopathy
  • paresthesia
    • the second most common complain after pain
  • weakness
    • reported in about 15% of patients
  • numbness
• look for myelopathic features in the history such as:
  • sensory disturbance multiple levels
  • stiffness of the upper and lower limbs
  • acute change in bowel or bladder function

Physical examination

• look for abnormalities of the spine e.g. - kyphosis, scoliosis, loss of normal lordosis of the cervical spine
• examine for signs of cervical radiculopathy:
  • postural asymmetry
    • the head may be held to one side or flexed
  • neck movements
    • may be restricted, or sharp pain may radiate into the arms (especially on extension or on bending or turning to the affected side)
  • neurological examination
    • examination of the upper extremities
      • motor testing at the shoulders, elbows, wrists and hands to assess any weakness
      • sensory testing of all dermatomes
• provocative tests can be used to assist the diagnosis - commonly used tests include:
  • Spurling test
    • has a high specificity (94%) and low sensitivity (30%)
  • shoulder abduction test
  • valsalva manouvre
  • neck distraction
  • Elveys upper limb tension test (ULTT)
• test for cervical myelopathy
  • patients with myelopathy will present with upper motor neuron signs including hyperreflexia, changes in gait, and also have difficulty with fine motor tasks (changes in handwriting, buttoning shirts, etc.)

Imaging

• radiographs
  • AP and lateral views of the cervical spine - examine disc height and the presence of degenerative changes
  • oblique view - may be considered to allow for better evaluation of the foramen.
• MRI

Additional testing

• electromyographic (EMG) studies - useful in differentiating peripheral nerve entrapment syndromes from cervical radiculopathy (1,2,3).

Reference:

• (1) Iyer S, Kim HJ. Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine. 2016;9(3):272-280.
• (2) Onks CA, Billy G. Evaluation and treatment of cervical radiculopathy. Prim Care. 2013 Dec;40(4):837-48, vii-viii.
• (3) The Royal Australian College of General Practitioners (RACGP). Clinical guidelines. Cervical radiculopathy