What are the symptoms of cervical radiculopathy?

Symptoms of Cervical Radiculopathy

Cervical radiculopathy presents primarily as a combination of neck pain with pain in one arm accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution. 1, 2

Primary Clinical Presentation

• Pain radiating from the neck into one arm following a specific dermatomal pattern is the hallmark symptom of cervical radiculopathy 2, 3
• Sensory dysfunction manifesting as numbness, tingling, or paresthesia in the affected dermatome 2, 4
• Motor weakness in specific muscle groups corresponding to the affected nerve root 2, 5
• Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding 4, 6

Diagnostic Patterns

• The annual incidence of cervical radiculopathy is approximately 83.2 per 100,000 people, making it less prevalent than general neck pain 1
• Most commonly results from compressive causes related to:
  • Narrowing of the neural foramina due to facet or uncovertebral joint hypertrophy 1, 2
  • Disc bulging or herniation 1, 3
  • Degenerative spondylosis 1

Physical Examination Findings

• Painful neck movements and muscle spasm are common examination findings 4, 7
• Specific tests that can help confirm the diagnosis include:
  • Spurling test (extension and lateral flexion of the neck toward the affected side reproduces symptoms) 4, 6
  • Shoulder abduction test (relief of symptoms when placing hand on top of head) 4
  • Upper limb tension test (reproduction of symptoms with arm positioning) 4

Important Clinical Considerations

• Most cases of acute cervical radiculopathy resolve spontaneously or with conservative treatment measures 1, 7
• There is limited evidence for correlation between physical examination findings and MRI evidence of cervical nerve root compression, with high rates of both false-positive and false-negative findings 1
• "Red flags" that require immediate attention include trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases (ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, inflammatory arthritis), suspected infection, history of intravenous drug use, intractable pain despite therapy, or tenderness to palpation over a vertebral body 1
• Additional concerning signs include congenital findings, concomitant vascular disease in patients >50 years of age, abnormal labs (erythrocyte sedimentation rate, C-reactive protein level, white blood cell count), and progressive neurological deficits 1

Diagnostic Approach

• MRI is the preferred imaging modality for suspected cervical radiculopathy when imaging is indicated 2, 5
• CT provides good definition of bony elements and is helpful in the assessment of neuroforaminal stenosis secondary to uncovertebral or facet hypertrophy 1
• In absence of red flag symptoms, imaging may not be required at time of initial presentation as spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of neck pain 1

Prognosis

• The overall prognosis for patients with cervical radiculopathy is favorable 4, 7
• Non-operative management is successful in 75-90% of patients 2, 7
• Surgical intervention is typically reserved for patients with persistent symptoms despite conservative treatment or those with progressive neurological deficits 3, 6