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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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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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