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Diagnosis of cervical radiculopathy

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:

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