Common symptoms of cervical radiculopathy
What are common presentations of cervical radiculopathy?
- C5: May have weakness with shoulder abduction and external rotation. Muscles affected may be the rhomboid, deltoid, biceps, and infraspinatus muscles. This may affect the biceps reflex.
- C6: Weakness with shoulder external rotation and elbow flexion. Muscles affected include the infraspinatus, biceps, brachioradialis, triceps, and pronator teres muscles. Affects biceps and brachioradialis reflexes. Affects sensation down the lateral extremity to the first and second digits of the hand.
- C7: Affects elbow extension and forearm pronation. Weakness of the triceps, pronator teres, and flexor carpi radialis. Will affect the triceps reflex. Affects sensation along the posterior extremity to the second and third digits.
- C8: May weaken finger abduction and grip strength. Muscles affected may include the flexor digitorum profundus, opponens pollicis, flexor pollicis longus, and hand intrinsics. Can affect sensation along the medial upper extremity and fourth and fifth digits of the hand.
Cervical myelopathy is marked by mechanical compression of the spinal cord. This compression produces spinal cord ischemia when the venous and arterial distribution is compromised. Common causes of compression include degenerative narrowing, disc herniation, or trauma. Spondylosis, or cervical spondylotic myelopathy, is the most common cause of myelopathy in those 55 and older. Cervical myelopathy can present as vague weakness or sensory changes in the arms or legs. Hyperreflexia/hyporeflexia, gait disturbance, bowel or bladder changes may all occur. Some may experience a positive Lhermitte sign, which is described as a shock-like sensation down the spine or into the arms with cervical flexion. This positive sign confirms cord injury. If there is clinical suspicion of cervical myelopathy, then an MRI or CT myelogram should be ordered to confirm. Central canal diameter less than 14 mm can be attributed to myelopathic changes of the spinal cord. Nonsurgical treatment includes rest, bracing, activity restriction, and pharmacologic pain management. Surgical decompression is a more invasive means of treatment if all else is ineffective
Although the most common source of neck pain is related to musculoskeletal complaints, other diagnoses to account for neck discomfort should not be excluded. Tumors, arterial dissections (carotid and vertebral arteries), infection (herpes zoster, Lyme disease), abscess formation or meningitis, and migraines should also be considered.