What are the signs and symptoms of cervical radiculopathy?

Signs and Symptoms of Cervical Radiculopathy

Cervical radiculopathy presents primarily with unilateral neck pain radiating to the ipsilateral arm, often accompanied by sensory changes in a dermatomal distribution, weakness, and reflex changes. 1

Key Clinical Manifestations

Pain Characteristics

• Neck pain with radiation to one or both upper extremities 2
• Pain often follows a specific dermatomal pattern corresponding to the affected nerve root
• Pain may worsen with neck movements, particularly extension and lateral rotation toward the affected side

Neurological Findings

• Sensory deficits:

  • Hypoesthesia (decreased sensation) in the affected dermatome 3
  • Paresthesia (tingling, pins and needles sensation) 3
  • Numbness in the upper extremity 2

• Motor deficits:

  • Weakness in specific muscle groups corresponding to the affected nerve root 1
  • Reduced grip strength 3
  • Decreased power in the affected extremity 3

• Reflex changes:

  • Diminished deep tendon reflexes, particularly of the triceps (most common neurological finding) 2
  • Reflex changes corresponding to the affected level

Diagnostic Tests

Physical Examination Tests

1. Spurling test (positive finding): Neck extension and lateral rotation toward the affected side reproduces radicular symptoms 2, 3
2. Shoulder abduction test (positive finding): Relief of symptoms when placing the hand of the affected arm on top of the head 2
3. Upper limb tension test (positive finding): Reproduction of symptoms with specific positioning of the arm 2

Common Causes and Pathophysiology

• Most commonly results from degenerative disease in the cervical spine 2
• Cervical disc herniation and cervical spondylosis are the primary causes 4
• Compression or irritation of nerve roots in the cervical spine leads to the characteristic symptoms 2

Diagnostic Imaging

• MRI is the gold standard for evaluating suspected cervical radiculopathy 5
• Imaging is not required unless there is:
  • History of trauma
  • Persistent symptoms
  • Red flags for malignancy, myelopathy, or abscess 2

Red Flags Requiring Urgent Evaluation

• Progressive neurological deficits 5, 1
• Signs of myelopathy (spinal cord compression) 1
• Bladder or bowel dysfunction 5
• History of cancer or unexplained weight loss 5
• Fever or signs of infection 5
• Severe unremitting night pain 5

Clinical Pearls and Pitfalls

• Cervical radiculopathy is most prevalent in persons 50 to 54 years of age 2
• Electrodiagnostic testing is not needed if the diagnosis is clear but has utility when peripheral neuropathy is a likely alternative diagnosis 2
• It's crucial to distinguish between conditions that may mimic cervical radicular compression syndromes through meticulous physical examinations 4
• Most cases will resolve regardless of the type of treatment, so reassurance is an important component of management 2

Management Considerations

• Initial management should focus on conservative approaches:

  • Physical therapy involving strengthening, stretching, and potentially traction
  • NSAIDs and muscle relaxants
  • Short-term use of cervical collars for immobilization 6

• Surgical intervention is indicated for:

  • Debilitating pain despite conservative management
  • Progressive neurological deficits
  • Significant weakness
  • Instability or myelopathy 1

The American College of Radiology recommends categorizing neck pain into grades, with Grade III representing neck pain with neurological signs of nerve compression (radiculopathy) 5, which guides appropriate management and imaging decisions.