Pathophysiology

  • Compression of cervical nerve root resulting in radicular pain along the corresponding dermatome in the upper limb
  • Causes: Degenerative changes including cervical disc herniation or spondylosis 
  • C7 is the most common nerve root, then C6.

Clinical Features

  • Neck pain
  • Pain along the corresponding dermatome in the arm, often shooting or burning 
  • Night pain
  • Sensory symptoms - paraesthesia, loss or reduced sensation along affected dermatome
  • Motor symptoms - weakness 
  • Examination
    • Restricted neck movements
    • C6 nerve root
      • Weakness in elbow flexion and wrist extension
      • Reflexes: Biceps and supinator affected
      • Sensory changes: Along lateral forearm, thumb and first finger
    • C7 nerve root
      • Weakness in elbow extension, wrist flexion and finger extension
      • Reflexes: Triceps reflex affected 
      • Sensory changes: Middle finger
    • Spurling's test positive:
      • Also known as a maximal cervical compression, Spurling's test involves:
        • Extending the neck
        • Tilting and rotating the head to the affected side
        • Gently applying pressure to the head and neck
      • The test is considered positive if it reproduces radiculopathic pain, weakness or sensory changes. 

Management

  • If red flags are present, or there is severe progressive neurology, seek immediate specialist advice
  • If cervical radiculopathy has been present for < 4-6 weeks and there are no neurological signs on examination - conservative management, including simple analgesia. Consider neuropathic analgesia if required. 
  • If cervical radiculopathy has been present for > 4-6 weeks or in the presence of objective neurological findings on examination:
    • Perform MRI imaging to confirm the diagnosis
    • Refer for consideration of spinal injections / surgery (indicated if progressive motor weakness/unremitting pain despite 6-12 weeks of conservative management), where MRI confirms compression. 
Figure 216: CT scan of a 52 year old man with left sided pain in his neck, as well as radicular pain in his left arm, with tingling sensation paresthesia in fingers 1-3. Spurling's test was positive. Triceps reflex was decreased. The scan shows spondylosis with osteophytes between the vertebral bodies C6 and C7 on the left side, causing foraminal stenosis at this level (lower arrow, also showing axial plane), thus explaining his symptoms by compression of C7 nerve.

References:

NICE CKS. Neck Pain - Cervical Radiculopathy [November 2023]. Available here.