What is the typical distribution of pain and numbness in cervical radiculopathy?

Typical Distribution of Pain and Numbness in Cervical Radiculopathy

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

Clinical Presentation

• Pain radiates in a dermatomal distribution from the neck into the arm, often with sensory changes (numbness, tingling) corresponding to the compressed nerve root 2, 3
• Motor dysfunction, sensory deficits, and reflex changes occur according to the specific dermatomal distribution of the affected nerve root 4
• Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding 5
• Symptoms may include unilateral neck pain with radiation to the ipsilateral arm and sensory changes that follow specific dermatomes 3

Pathophysiology

• Most commonly results from compressive causes related to narrowing of neural foramina due to:
  • Facet or uncovertebral joint hypertrophy
  • Disc bulging or herniation
  • Degenerative spondylosis 1, 2
• The annual incidence is approximately 83.2 per 100,000 people, making it less prevalent than general neck pain 2
• Compression and inflammation of the spinal nerves or nerve roots leads to the characteristic neurological dysfunction 4

Diagnostic Considerations

• Physical examination findings may correlate poorly with MRI evidence of cervical nerve root compression, with high rates of both false-positive and false-negative findings 1, 2
• The Spurling test, shoulder abduction test, and upper limb tension test can help confirm the diagnosis 5
• Most cases resolve spontaneously or with conservative treatment measures (75-90% success rate with non-operative management) 2, 1
• MRI is the preferred imaging modality when imaging is indicated, while CT provides better definition of bony elements 2

Common Pitfalls and Caveats

• It's essential to differentiate cervical radiculopathy from other conditions that may mimic its presentation, such as peripheral neuropathy of the upper extremity 5
• Imaging may not be required at initial presentation unless there are "red flags" such as:
  • Trauma, malignancy, prior neck surgery
  • Spinal cord injury, systemic diseases
  • Suspected infection, history of intravenous drug use
  • Intractable pain despite therapy
  • Tenderness to palpation over a vertebral body 1, 2
• Additional concerning signs include congenital findings, vascular disease in patients >50 years, abnormal labs, and progressive neurological deficits 2
• Spondylotic changes are commonly identified on imaging in patients >30 years of age and correlate poorly with the presence of neck pain 1, 2

Management Approach

• Initial management should be non-operative, as most cases (90%) respond well to conservative treatment 1
• Surgery should be considered for patients with intractable or persistent pain despite sufficient conservative management, or with severe or progressive neurological deficits 4
• A multimodal approach including physical therapy, medications, and potentially selective nerve blocks may benefit patients with cervical radiculopathy 6