Clinical features and diagnosis of cervical radiculopathy
- Jenice Robinson, MD
Jenice Robinson, MD
- Assistant Professor Case Medical Center
- Neuroscience Institute
- Milind J Kothari, DO
Milind J Kothari, DO
- Professor of Neurology
- Penn State College of Medicine
Neck pain is extremely common and may arise from a number of causes. Cervical spondylosis and disc herniation were not thought to be causes of neck and arm pain until the 1940s, when ruptured cervical discs were first recognized as a cause of radicular symptoms in the arm in the absence of myelopathy [1,2]. In the early 20th century, symptoms now attributed to cervical radiculopathy were often ascribed to scalenus anticus compression of the brachial plexus and were treated by surgical section of the muscle.
Today, compressive cervical radiculopathy is recognized to be a common source of arm pain with or without sensory and motor dysfunction.
This topic will review the anatomy, pathophysiology, epidemiology, clinical evaluation, and diagnosis of cervical radiculopathy. The treatment of cervical radiculopathy is discussed separately. (See "Treatment and prognosis of cervical radiculopathy".)
The following is a brief review of the anatomy and bony architecture of the cervical spine.
Spinal column and joints — The cervical spinal column is comprised of seven vertebral bodies. The C1 vertebra (also known as the atlas) is a circular ring of bone without a body or a spinous process. The atlas connects the spine to the occipital bone of the skull superiorly, and articulates with the C2 vertebra (also known as the axis) inferiorly, without an intervening vertebral disc (figure 1).
- Semmes, R, Murphey, M. The syndrome of unilateral rupture of the sixth cervical intervertebral disk with compression of the seventh cervical nerve root. A report of four cases with symptoms simulating coronary disease. JAMA 1943; 121:1209.
- Spurling, R, Scoville, W. Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet 1944; 78:350.
- Levin K. Cervical Radiculopathies. In: Neuromuscular disorders in clinical practice, Katirji M, Kaminski H, Preston D, et al. (Eds), Butterworth-Heinemann, Boston 2001. p.836.
- Yabuki S, Kikuchi S. Positions of dorsal root ganglia in the cervical spine. An anatomic and clinical study. Spine (Phila Pa 1976) 1996; 21:1513.
- Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clin Orthop Relat Res 1989; :69.
- Storm PB, Chou D, Tamargo RJ. Surgical management of cervical and lumbosacral radiculopathies: indications and outcomes. Phys Med Rehabil Clin N Am 2002; 13:735.
- Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117 ( Pt 2):325.
- Preston D, Shapiro B. Radiculopathy. In: Electromyography and Neuromuscular Disorders, Butterworth-Heinemann, Boston 2005. p.459.
- YOSS RE, CORBIN KB, MACCARTY CS, LOVE JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology 1957; 7:673.
- Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil 1994; 75:342.
- Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med 2005; 353:392.
- Kelsey JL, Githens PB, Walter SD, et al. An epidemiological study of acute prolapsed cervical intervertebral disc. J Bone Joint Surg Am 1984; 66:907.
- Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976) 1989; 14:253.
- Tong HC, Haig AJ, Yamakawa K. The Spurling test and cervical radiculopathy. Spine (Phila Pa 1976) 2002; 27:156.
- Rubinstein SM, Pool JJ, van Tulder MW, et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 2007; 16:307.
- Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology 1987; 164:83.
- Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72:1178.
- Nardin RA, Patel MR, Gudas TF, et al. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 1999; 22:151.
- Hehir MK, Figueroa JJ, Zynda-Weiss AM, et al. Unexpected neuroimaging abnormalities in patients with apparent C8 radiculopathy: broadening the clinical spectrum. Muscle Nerve 2012; 45:859.
- Lee HY, Chung IH, Sir WS, et al. Variations of the ventral rami of the brachial plexus. J Korean Med Sci 1992; 7:19.
- Uysal II, Seker M, Karabulut AK, et al. Brachial plexus variations in human fetuses. Neurosurgery 2003; 53:676.
- Matejcik V. Variations of nerve roots of the brachial plexus. Bratisl Lek Listy 2005; 106:34.
- Yousem DM, Atlas SW, Goldberg HI, Grossman RI. Degenerative narrowing of the cervical spine neural foramina: evaluation with high-resolution 3DFT gradient-echo MR imaging. AJNR Am J Neuroradiol 1991; 12:229.
- Bartlett RJ, Hill CR, Gardiner E. A comparison of T2 and gadolinium enhanced MRI with CT myelography in cervical radiculopathy. Br J Radiol 1998; 71:11.
- Tsuruda JS, Remley K. Effects of magnetic susceptibility artifacts and motion in evaluating the cervical neural foramina on 3DFT gradient-echo MR imaging. AJNR Am J Neuroradiol 1991; 12:237.
- Modic MT, Masaryk TJ, Mulopulos GP, et al. Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology 1986; 161:753.
- Houser OW, Onofrio BM, Miller GM, et al. Cervical neural foraminal canal stenosis: computerized tomographic myelography diagnosis. J Neurosurg 1993; 79:84.
- Ross JS, Robertson JT, Frederickson RC, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 1996; 38:855.
- Gough JG, Koepke GH. Electromyographic determination of motor root levels in erector spinae muscles. Arch Phys Med Rehabil 1966; 47:9.
- Spinal column and joints
- Intervertebral foramina
- Nerve roots and dorsal root ganglia
- Cervical spondylosis
- Disc herniation
- Nondegenerative causes
- Danger signs
- Antecedent events
- Spurling maneuver
- Shoulder abduction relief test
- Imaging studies
- - MRI
- - CT myelography
- - Plain radiographs
- - Issues related to prior surgery
- Electrodiagnostic studies
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS