From the Guidelines
No, a cervical spine radiculopathy does not always present with neck pain. While the most common clinical presentation is 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, some patients may experience only arm pain, numbness, tingling, or weakness that radiates along the affected nerve root distribution without any neck discomfort. This occurs because radiculopathy specifically refers to the compression or irritation of a nerve root as it exits the spinal canal, and the symptoms manifest primarily in the areas supplied by that particular nerve.
Key Points to Consider
- The classic presentation includes radiating pain along a dermatomal pattern, sensory changes like numbness or paresthesias, motor weakness in corresponding muscle groups, and diminished reflexes.
- The absence of neck pain is particularly common in cases where the nerve compression is gradual or when the pathology primarily affects the nerve root without significant involvement of surrounding neck structures.
- A recent study assessing the positive predictive value of physical examination tests in the setting of a clinical history of cervical radiculopathy concluded there was limited evidence for a correlation between physical examination findings and MRI evidence of cervical nerve root compression 1.
Diagnostic Approach
- In the absence of red flag symptoms, imaging may not be required at the time of initial presentation 1, 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.
- Treatment approaches, including physical therapy, anti-inflammatory medications, and in some cases surgical intervention, should be based on the specific symptoms and underlying cause rather than assuming neck pain must be present for diagnosis.
Important Considerations for Management
- Most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1.
- Red flags that include trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, suspected infection, history of intravenous drug use, intractable pain despite therapy, or tenderness to palpation over a vertebral body should be considered when evaluating a patient with cervical radiculopathy 1.
From the Research
Presentation of Cervical Spine Radiculopathy
- Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs, typically producing neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities 2.
- The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness 3.
- Pain is a common presenting symptom and may be accompanied by motor or sensory deficits in areas innervated by the affected nerve root 4.
Association with Neck Pain
- Cervical radiculopathy does not always present with neck pain, as the clinical presentation can vary and may include arm pain or paresthesias without neck pain 3, 4.
- While neck pain is a common symptom, the presence and severity of neck pain can vary among individuals with cervical radiculopathy 2, 5.
- A multimodal approach to treatment, including medications, physical therapy, and manipulation, may help alleviate neck discomfort and improve symptoms in patients with cervical radiculopathy 2, 4.