Can unilateral tingling in the arm and leg be caused by C-spine (cervical spine) radiculopathy?

Unilateral Tingling in Arm and Leg from Cervical Radiculopathy

Yes, unilateral tingling in both the arm and leg can be caused by cervical spine radiculopathy, though this presentation is atypical and should prompt evaluation for other potential causes. 1, 2

Pathophysiology and Clinical Presentation

• Cervical radiculopathy occurs when a cervical nerve root is compressed or irritated, typically causing symptoms in a specific dermatomal distribution in the upper extremity 1
• Classic cervical radiculopathy presents with radiating pain, sensory dysfunction, and possibly motor weakness in the affected nerve root distribution, usually limited to the neck and arm 2
• Most commonly affects C5-C6 and C7 nerve roots, with symptoms typically confined to the upper extremity 1, 3

Atypical Presentation with Leg Symptoms

• When unilateral arm and leg symptoms occur together, this raises concern for:
  • Possible cervical myelopathy (spinal cord compression) rather than simple radiculopathy 4
  • Multiple levels of nerve root compression affecting both cervical and lumbar spine 4
  • Plexopathy rather than radiculopathy 4

Diagnostic Approach

• MRI of the cervical spine is the preferred imaging modality to evaluate for cervical radiculopathy with atypical presentation 1, 5
• Electrodiagnostic testing may be necessary to differentiate between radiculopathy, plexopathy, and peripheral neuropathy when symptoms affect both upper and lower extremities 6
• Physical examination findings that support cervical radiculopathy include:
  • Painful neck movements and muscle spasm 6
  • Diminished deep tendon reflexes, particularly of the triceps 6
  • Positive Spurling test, shoulder abduction test, or upper limb tension test 6

Important Clinical Considerations

• Bilateral radiculopathy or symptoms affecting both upper and lower extremities may indicate risk for myelopathy, which requires more urgent evaluation 1
• The location of sensory impairments in cervical radiculopathy can overlap significantly between different nerve roots, making it difficult to precisely identify the affected level based on sensory symptoms alone 7
• When symptoms affect both arm and leg unilaterally, consider:
  • Cervical cord compression with long tract signs 4
  • Multiple sites of pathology 4
  • Non-spinal causes such as multiple sclerosis or other neurological disorders 4

Management Approach

• For confirmed cervical radiculopathy with typical presentation:
  • Initial conservative management includes physical therapy, NSAIDs, and activity modification 6
  • Surgical decompression should be considered when there is persistent or progressive neurological deficit despite conservative management 4, 1
• For atypical presentation with both arm and leg symptoms:
  • More comprehensive neurological workup is warranted 4
  • MRI of both cervical and lumbar spine may be necessary 4
  • Neurology consultation should be considered 4

Red Flags Requiring Urgent Evaluation

• Progressive neurological deficits 1
• New changes in bladder or bowel function 1
• Loss of perineal sensation 1
• Bilateral symptoms or signs of myelopathy 4, 1

While cervical radiculopathy typically causes symptoms in the neck and arm only, the presence of both arm and leg symptoms on the same side warrants careful evaluation to rule out more serious pathology such as cervical myelopathy or multiple sites of nerve compression.