Cervical radiculopathy is usually due to compression or injury to a nerve root by a herniated disc or degenerative changes. Levels C5 to T1 are the most commonly affected.30 It is usually, but not always, accompanied by cervical radicular pain, a sharp and shooting pain that travels from the neck and down the upper limb and may be severe. This needs to be differentiated from pain referred from the musculoskeletal (somatic) structures in the neck, which may be aching rather than sharp, and is more severe in the neck than in the upper limb.
The neurological signs of cervical radiculopathy depend on the site of the lesion. The patient may have motor dysfunction, sensory deficits or alteration in tendon reflexes. While pain is a common presenting symptom, not all radiculopathies are painful (i.e. only motor deficits may be obvious).30
Neurological features associated with cervical radiculopathy
For most patients with cervical radiculopathy from degenerative disorders, it is likely that signs and symptoms will be self-limited and will resolve spontaneously over a variable length of time without specific treatment.29 Patient education and discussion about options and expectations are important.
What presenting symptoms suggest cervical radiculopathy?
Patients may report pain in the neck, shoulder and/or arm that is usually unilateral, but may be bilateral. The pain may be severe enough to wake the person at night.30
Neurological signs reported are altered sensation or numbness, or weakness in related muscles. Sensory symptoms are more common than motor symptoms.30
Look for features suggestive of a serious spinal or other abnormality, including compression of the spinal cord (myelopathy), cancer, severe trauma or skeletal injury, and vascular insufficiency. If these are present, arrange referral.
Signs of serious spinal or other abnormalities
Examine for signs of cervical radiculopathy:
- Postural asymmetry: the head may be held to one side or flexed, as this decompresses the nerve root. If the asymmetry is long-standing, muscle wasting may be present.
- Neck movements: these may be restricted, or sharp pain may radiate into the arms (especially on extension or on bending or turning to the affected side).
- Dural irritation: assess with the Spurling test: the examiner extends the neck, sidebends it 30 degrees to the affected side and then applies axial compression to the head. The test is positive if this pressure causes the typical radicular arm pain.
- Neurological signs: for example, upper limb weakness, paraesthesiae, dermatomal sensory or motor deficit, or diminished tendon reflexes at the appropriate level. Nerve root symptoms should normally arise from a single nerve root: involvement of more than one nerve root suggests a more widespread neurological disorder.30
Manual provocation tests (e.g. Spurling), designed to elicit nerve root compression in the cervical spine, have high positive predictive value.31
It is suggested that the diagnosis of cervical radiculopathy be considered in patients with arm pain, neck pain, scapular or periscapular pain, and paraesthesias, numbness and sensory changes, weakness, or abnormal deep tendon reflexes in the arm.29
Cervical radiculopathy can also be considered in patients with atypical findings such as deltoid weakness, scapular winging, weakness of the intrinsic muscles of the hand, chest or deep breast pain, and headaches.29