What is the definition of cervical radiculopathy and how can I chart its symptoms?

Definition and Charting of Cervical Radiculopathy

Definition

Cervical radiculopathy is characterized by upper limb pain or sensorimotor deficit secondary to cervical nerve root impingement and/or irritation, frequently presenting as neck and/or upper limb pain with or without varying degrees of sensory or motor deficits. 1 It is a syndrome caused by compression of a cervical nerve root resulting in pain and/or sensorimotor deficits that follow a dermatomal distribution 2.

The compression or irritation of cervical nerve roots can be caused by:

• Soft disc herniation
• Hard disc (spondylarthrosis such as facet or uncovertebral joints)
• A combination of both 1

Epidemiology and Natural History

• Annual incidence: 83 per 100,000 persons 1
• Most prevalent in persons 50-54 years of age 3
• Cervical radiculopathy is frequently self-limiting, with 75-90% of patients achieving symptomatic relief with nonoperative conservative therapy 1

Charting the Symptoms

Key Elements to Document

1. Pain Characteristics:

   • Location: Document neck pain and radiating arm pain following specific dermatomal patterns
   • Quality: Sharp, burning, electric, dull, or aching
   • Severity: Use Visual Analog Scale (VAS) 0-10
   • Timing: Constant vs. intermittent
   • Aggravating/alleviating factors: Document activities that worsen or improve symptoms

2. Sensory Deficits:

   • Document specific dermatomal distribution of sensory changes
   • Note paresthesias, numbness, or tingling in affected dermatomes
   • Chart sensory testing results by dermatome (normal, decreased, or absent)

3. Motor Deficits:

   • Document muscle strength testing using the 5-point scale:
     • 5/5: Normal strength
     • 4/5: Active movement against resistance
     • 3/5: Active movement against gravity
     • 2/5: Active movement with gravity eliminated
     • 1/5: Muscle contraction without movement
     • 0/5: No contraction
   • Specify affected muscle groups corresponding to nerve roots

4. Reflex Changes:

   • Document deep tendon reflexes (biceps, brachioradialis, triceps) using the scale:
     • 4+: Hyperactive with clonus
     • 3+: Brisker than average
     • 2+: Normal
     • 1+: Diminished
     • 0: Absent
   • Note that diminished triceps reflexes are the most common neurologic finding 3

5. Provocative Tests:

   • Document results of specific tests:
     • Spurling test (neck extension and lateral rotation toward affected side)
     • Shoulder abduction test
     • Upper limb tension test 3

6. Functional Impact:

   • Document limitations in activities of daily living
   • Note impact on work or recreational activities
   • Use validated tools like Neck Disability Index (NDI) to quantify disability

Nerve Root-Specific Findings to Chart

Nerve Root	Pain Distribution	Sensory Changes	Motor Weakness	Reflex Changes
C5	Lateral arm, shoulder	Lateral arm	Deltoid, biceps	Biceps reflex ↓
C6	Lateral forearm, thumb, index finger	Thumb, index finger	Biceps, wrist extensors	Brachioradialis reflex ↓
C7	Middle finger, posterior forearm	Middle finger	Triceps, wrist flexors	Triceps reflex ↓
C8	Medial forearm, ring and little fingers	Ring and little fingers	Hand intrinsics, finger flexors	None specific

Diagnostic Workup to Document

1. Imaging Results:

   • Document findings from:
     • Cervical spine radiographs (for spondylosis, degenerative disc disease, malalignment)
     • MRI (for neural foraminal narrowing, disc herniation, nerve root compression)
     • CT (if MRI contraindicated; for osseous structures like osteophytes)

2. Electrodiagnostic Studies (if performed):

   • Document EMG/NCS findings confirming radiculopathy
   • Note any evidence of denervation in specific myotomes

Treatment Response Documentation

1. Conservative Management:

   • Document response to NSAIDs/COXIBs at maximum tolerated dosage
   • Note response evaluation at 2-4 weeks and 12 weeks 4
   • Document physical therapy interventions and response
   • Record use and effectiveness of cervical collar immobilization

2. Interventional Procedures:

   • Document epidural steroid injections and response
   • Note any other interventional pain management techniques

3. Surgical Considerations:

   • Document persistence of symptoms despite 6+ weeks of comprehensive conservative management
   • Note any progressive neurological deficits or evidence of myelopathy 4

Important Charting Pitfalls to Avoid

1. Avoid overreliance on imaging - MRI alone should not be used to diagnose symptomatic cervical radiculopathy and should always be interpreted in combination with clinical findings, given frequent false-positive and false-negative MRI findings 1

2. Document differential diagnosis - Include assessment of peripheral nerve entrapment syndromes and shoulder pathology that may mimic cervical radiculopathy 5

3. Ensure complete neurological examination - Incomplete neurological examination may miss specific nerve root involvement 4

By systematically documenting these elements, you can create a comprehensive clinical picture of cervical radiculopathy that facilitates appropriate treatment decisions and tracks patient progress over time.