Cervical Radiculopathy

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Original Editor - Thomas Rodeghero, Stéphanie Dartevelle

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Definition/Description

Cervical radiculopathy occurs with pathologies that causes symptoms on the nerve roots. ^[14] Those can be for example compression, traction, … on the nerve root caused by several reasons, for example: herniated disk, foraminal narrowing, degenerative spondylotic change (= joint disease on cervical vertebrae), …. . ^{[14], [17]} (We got 8 cervical nerve roots, for 7 cervical vertebrae) ^[14]
Most of the time cervical radiculopathy is unilateral. If radiation is present, the place of the pain depends on the concerned nerve root. ^[14]

Clinically Relevant Anatomy

Cervical radiculopathy is defined as a disorder affecting a spinal nerve root in the cervical spine.  Therefore, the most relevant anatomy is related to the cervical spine, such as the vertebral discs, facet joints, and the spinal nerve roots.

Epidemiology /Etiology

The most common cause of cervical radiculopathy are cervical disc herniations or other space-occupying lesions that impinge and/or cause nerve root irritation The reported annual incidence of cervical radiculopathy is approximately 83 per 100,000, and increases to 203 per 100,000 in the fifth decade of life and beyond

Characteristics/Clinical Presentation

The typical presentation of cervical radiculopathy is neck pain with associated upper extremity symptoms.  Numbness and weakness in the upper extremities are commonly reported.  Often, there is a decrease in cervical spine range of motion (ROM) with exacerbation of symptoms into the upper extremities with cervical movements.  This also commonly results in a decrease in muscle length of the cervical spine musculature (upper trapezius, scalenes, levator scapula).

Differential Diagnosis

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Diagnostic Procedures

The most common diagnostic method has been imaging studies (radiograph and MRI) and electrophysiologic studies (EMG).  In 2003, Dr. Robert Wainner and colleagues examined the accuracy of the clinical examination and developed a clinical prediction rule to aid in the diagnosis of cervical radiculopathy.  Their research demonstrated that these 4 clinical tests, when combined, hold high diagnostic accuracy compared to EMG studies:  Positive tests for Spurling-A, Upper limb tension-A, and distraction sign along with cervical rotation of the involved side less than 60 degrees (see resources for more information regarding these tests).  When all 4 of these clinical features are present, the post-test probablity of cervical radiculopathy is 90%.

Outcome Measures

FABQ

NDI

Neck Pain and Disability Scale

Examination

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Medical Management

There are several intervention strategies for managing cervical radiculopathy with physical therapy and surgical interventions being the most common.  Long-term benefits of surgical interventions are questionable with reported numbers of 25% of people continuing to experience pain and disability at 12 month follow-ups.  There is a significant amount of evidence available to support the use of physical therapy interventions for patients with cervical radiculopathy, and the benefit of physical therapy and manual techniques in general for patients with neck pain with or without radicular symptoms (see key evidence for a list of references).

Physical Therapy Management

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Regarding physical therapy interventions, in 2007 Joshua Cleland and colleagues examined the predictors of positive short-term outcomes in people with a clinical diagnosis of cervical radiculopathy.  The following clinical features were found to be most predictive of a positive short-term outcome:

• Age <54

• Dominant arm not affected

• Looking down does not worsen symptoms

• Treatment involves manual therapy, cervical traction, and deep neck flexor strengthening for at least 50% of visits

If 3 of these features are present, the probability of success is 85%, and increases to 90% if all 4 are present

Differential Diagnosis

• Spinal Tumor
  

• Systemic diseases known to cause peripheral neuropathies

• Cervical myelopathy

• Ligamentous Instability

• Vertebral Artery Insufficiency (VBI)

• Herniated nucleous pulposos (HNP)

Key Evidence

The following are key evidence pieces for physical therapy interventions as they relate to both cervical radiculopathy and neck pain in general:

Manual therapy compared to 'usual' physical therapy and general practitioner care

Clinical Practice Guidelines

Classification System for Neck Pain

Proposal of Treatment-Based Classification System

Prognostic factors for neck pain in the general population

Immediate effects of thoracic manipulation for patients with neck pain

Clinical prediction rule for thoracic manipulation in patients with neck pain

Resources

CPR for cervical radiculopathy

CPR for traction for neck pain

Upper Limb Tension Test - A

Clinical Practice Guidelines for Neck Pain

Spurling's Test

WebMD

Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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