cervical radiculopathy. normal anatomy cervical spinal nerves exit via the intervertebral foramen...
TRANSCRIPT
Cervical Radiculopathy
Normal Anatomy• Cervical spinal nerves exit
via the intervertebral foramen
• Intervertebral foramen is the gap between the facet joint and vertebral body
• Cervical nerves are named corresponding to the vertebral body below, up to C8 nerve root which exits between C7 and T1
Pathophysiology
• Cervical radiculopathy is a syndrome of radiating pain and sensory and/or motor deficit due to compression or injury of a cervical nerve root
• Injury or compression of the nerve root can be caused by anything that occupies the intervertebral foraminal space
• Radiculopathy– state of neurological loss i.e sensation, reflex, motor due to
blocked axon conduction in the nerve
• Radicular pain – pain that arises due to irritation of the spinal nerve or nerve
root
Mechanism Of Injury
• Insidious– Degenerative Disc
Disease/Spondylosis– Intervertebral Disc Herniation– Osteophytes– Ossification of longitudinal
ligament– Instability– Tumor
• Traumatic– Road Traffic Accident– Direct impact or compression
Subjective
• Paraesthesia, numbness or motor changes in a nerve root pattern +/- arm pain
• Neck and/or scapular pain• Coughing and sneezing may worsen the pain or tingling in
the arm• Aggravated by long static position, first thing in the
morning or ipsilateral rotation• Pain may be unrelenting causing restlessness and loss of
sleep• May find short term relief by raising the arm above the
head
Objective
• Pain and/or aggravation of neurological symptoms with movements that close down intervertebral foramen (Extension, ipsilateral rotation, ipsilateral side flexion)
• Reduced sensation, power and reflex’s in a nerve root pattern
• Abnormal upper limb tension testing• Rarely movements towards the side of pain relieve
symptoms • Antalgic postures that correspond to unloading of
sensitive neural tissues
Special Tests
• Spurling’s test• Valsalva Maneuver• Shoulder abduction sign• Upper limb tension test• Neck distraction
Clinical prediction rule
Positive findings on 3 of the following:• Positive Spurlings test• Positive distraction test• Ipsilateral cervical spine rotation less than 60
degrees.• Positive upper limb tension test-median nerve
bias.
Further Investigation
• MRI• CT myelography• Electromyography or
nerve conduction studies
General Management
• Conservative management usually effective in• Education on cause of pain very important in
these cases• Priority to improve neurological or peripheral
symptoms
Conservative Management• Reduce Inflammation
– Ice, NSAID’s, Massage• Restore Normal ROM
– Cervical, Thoracic and Shoulder– Soft Tissue Techniques– Joint mobilisations, manipulations, tractions– Neurodynamic mobilisations– Cervical and Thoracic Stretches
• Restore Normal Muscle Activation– Cervical, Thoracic and Shoulder/Scapular– Deep Cervical flexors and extensors, scapular stabilisers
• Restore Dynamic Stability and Proprioception• Global shoulder girdle strengthening
Surgical Management• Indications of surgery
– Failure of conservative management after at least 6-12 weeks trial
– Progressive neurological deficit
• Epidural Steroid injection• Anterior decompression and
fusion• Discectomy with or without
fusion• Posterior laminoforaminotomy• Facetectomy