What tests are necessary to diagnose cervical radiculopathy (inflammation of a nerve root in the cervical spine) given symptoms of shoulder pain radiating down the arm, numbness, and tingling in the lower arm and fingers upon certain movements?

From the Guidelines

To diagnose cervical radiculopathy, an MRI of the cervical spine is the most necessary test, given its superior ability to visualize nerve compression and soft tissue contrast, as evidenced by a 2019 study in the Journal of the American College of Radiology 1. When symptoms such as shoulder pain radiating down the arm, numbness, and tingling in the lower arm and fingers upon certain movements are present, a thorough diagnostic approach is crucial. The diagnostic process typically begins with a thorough physical examination, including tests like Spurling's test, the shoulder abduction test, and assessments of reflexes, sensation, and muscle strength. However, for confirming the diagnosis and identifying the specific cause of nerve root compression, such as a herniated disc, bone spurs, or spinal stenosis, imaging studies are essential. While X-rays can be used to rule out bone abnormalities, they are limited by their inability to visualize soft tissues well. Nerve conduction studies and electromyography (EMG) can also be valuable in assessing nerve function and identifying which specific nerves are affected. But, the MRI stands out as the preferred method due to its high accuracy in predicting lesions, with a study by Brown et al cited in 1 showing that MRI correctly predicted 88% of the lesions. It's important to note that while MRI is highly sensitive, degenerative findings are common in asymptomatic patients, which can lead to false-positive findings. Despite this, in the context of clinical symptoms suggestive of cervical radiculopathy, an MRI of the cervical spine, as recommended by the 2019 acr appropriateness criteria1, is the key diagnostic test. Early diagnosis through these means can prevent long-term nerve damage and guide appropriate treatment, which may include physical therapy, medication for pain relief such as ibuprofen, and in some cases, surgical intervention.

From the Research

Diagnostic Tests for Cervical Radiculopathy

To diagnose cervical radiculopathy, given symptoms of shoulder pain radiating down the arm, numbness, and tingling in the lower arm and fingers upon certain movements, the following tests may be necessary:

• Myelography or discography, in addition to a routine careful investigation, to precisely identify the cause of pain 2
• Electrodiagnostic (EDX) evaluation, including electromyography (EMG), to confirm the diagnosis of cervical radiculopathy and predict outcomes after epidural steroid injections (ESI) 3
• Ultrasound examination to correlate clinical assessment with imaging signs and guide treatment decisions 4
• A thorough clinical examination, including physical examination and medical history, to aide in diagnosis and rule out other conditions such as thoracic outlet syndrome 5

Ruling Out Other Conditions

It is also important to consider other conditions that may cause similar symptoms, such as:

• Subdeltoid subacromial bursitis, glenohumeral joint capsulitis, calcific tendinosis, acromioclavicular joint osteoarthritis, and long head of biceps tendinosis, which can be diagnosed using ultrasound examination and treated with ultrasound-guided injection and other techniques 4
• Thoracic outlet syndrome, which can be diagnosed through a thorough clinical examination and appropriate clinical testing, and treated with timely therapeutic interventions 5
• Bony, infectious, and connective tissue pathologies, which can be diagnosed and treated in the emergency department 6