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Orthopaedic Clinic

Cervical radiculopathy 2

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Clinical features:
 
Neck pain:
 
Common in mid lower back, sub occipital region or anteriorly along the sternocleidomastoid muscle.
 
Radiation to the occiput, shoulder and periscapular region may occur.
 
Stiffness during neck movement and headaches often accompany the neck pain.
 
Localized area of tenderness or trigger points may be identified.
 
The location of pain may give an idea as of its origin:
 
Anterior neck pain: suggestive of sternocleidomastoid muscle sprain or strain.
 
Posterior neck pain worsening with flexion: posterior neck musculature sprain or strain.
 
Posterior neck pain worsening with extension: Discogenic pain.
 
Sub occipital pain: pain arising from C1 -C 3 vertebra.
 
Pain with rotation: Pathology associated with C1 -C2 articulation.
 
 
Radiculopathy: Can be divided into Local signs of neck pain as described above, Localising signs and tension signs.
 
Tension signs:
 
Spurling Manouver: Reproduction of radiating pain on extension and lateral rotaion of neck
 
Shoulder abduction sign: Relief of pain with overhead abduction of arm, typically resting wrist or forearm over the head.
 
Localising signs: Sensory, Motor and reflex examination will give an idea of the root involved.
 
C3 Root: disc pathology at this level is unusual. The posterior ramus innervates the suboccipital region and back of ear. No motor involvement.
 
C 4 Root: Pain, Paresthesia and numbness at the back of neck. Motor deficits may manifest as paradoxical breathing due to diaphragmatic involvement best illustrated by flouroscopic evaluation of the abdomen.
 
C 5 Root: Numbness in epaulet distribution, i. e from top of shoulder to lateral mid arm. Motor deficit involve weakness of deltoid muscle. subtle wekness of the rotator cuff (Supra and infra spinatus) and Biceps may also be ellicited. Bicep reflex supplied by C 5 and C 6 root is affected.
 
C 6 Root: Pain, Numbness, Paraesthesia in the lateral aspect of forearm and involing the thumb and index fingers. Motor weakness in the form of Wrist extension is usually present. Brachioradialis and Biceps reflexes are typically diminished or absent.
 
C 7 Root: Pain, numbness or paraesthesia along middle fingers. The motor weakness is manifested as weakness of wrist flexors, elbow extension and finger extension. Tricep reflex cis often diminished or absent.
 
C 8 root: Pain, Paraesthesia or numbness along the medial border of forearm and the ulnar two fingers. Motor weakness include those of small muscles of hand especially finger abductors. No specific reflexes.
 
Atypical presentations:
  • Cervical angina or pain simulating the anginal pain in pattren and distribution.
  • Facial pain or paraesthesia.
  • Breast pain.
  • Dysphagia, dysphonia or dyspnea secondary to compression by osteophyte.
  • Vertebral artery thrombosis.
  • Sympathetic chain involvement secondary to compression by osteophyte leading to Horners syndrome.

Differential Diagnosis:

Thoracic Outlet Syndrome.

Carpal tunnel syndrome.

entrapment neuropathy

epidural abscess.

Brachial neuritis.

Cardiac Ischemia.

intraspinal or extraspinal tumors.

Shoulder dyfunction

Temporomandibular Joint Dysfunction.

Local lymphadenitis.

 
 
 
 

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