🔑 Key Learning

  • Caused by compression of a cervical nerve root, typically C7 or C6.
  • Presents with neck pain, radicular arm pain, and dermatomal sensory or motor symptoms.
  • Diagnosis is clinical, confirmed by MRI if symptoms persist > 4–6 weeks or if there is objective neurology.
  • Initial management is conservative unless red flags or severe neurology are present.

🧬 Pathophysiology

  • Nerve root compression causes radicular pain and neurology along the affected dermatome.
  • Most common causes:
    • Degenerative disc disease
    • Cervical disc herniation
    • Cervical spondylosis
  • Most frequently affected nerve roots:
    • C7 (most common)
    • C6 (next most common)

👀 Clinical Features

Symptoms

  • Neck pain
  • Radiating arm pain – often burning or shooting, following a dermatomal distribution
  • Night pain
  • Sensory symptoms – paraesthesia, numbness in a dermatomal pattern
  • Motor symptoms – weakness in corresponding myotomes

🧪 Examination

General

  • Restricted neck movement
  • Spurling's test positive:
    • Neck extension, lateral rotation, and axial compression reproduce pain or neurology
    • Suggestive of radiculopathy

C6 Nerve Root

  • Motor: Weakness in elbow flexion and wrist extension
  • Reflexes: Decreased biceps and supinator reflex
  • Sensation: Lateral forearm, thumb, and index finger

C7 Nerve Root

  • Motor: Weakness in elbow extension, wrist flexion, finger extension
  • Reflex: Decreased triceps reflex
  • Sensation: Middle finger

🧪 Investigations

  • Clinical diagnosis if < 4–6 weeks and no red flags
  • MRI cervical spine:
    • If symptoms persist > 4–6 weeks
    • If neurological deficit is present
  • May show disc herniation, osteophytes, or foraminal stenosis
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.

     

💊 Management

Immediate referral

  • If red flags or progressive neurological signs
    • Refer urgently for spinal surgical opinion

Conservative

  • If symptoms < 4–6 weeks and no neurological deficit:
    • Simple analgesia (e.g. paracetamol, NSAIDs)
    • Consider neuropathic analgesia (e.g. amitriptyline, gabapentin)
    • Physiotherapy

Further Management

  • If symptoms > 4–6 weeks or objective neurology on exam:
    • Perform MRI
    • Refer for specialist management
      • Consider spinal injections
      • Consider surgery (e.g. decompression, discectomy) if:
        • Progressive weakness
        • Persistent pain despite 6–12 weeks of conservative therapy

📝 Exam Clues & Clinchers

  • Neck pain + radiating arm pain + sensory loss → think cervical radiculopathy
  • C7 = triceps weakness, middle finger sensory loss
  • Spurling’s test helps reproduce symptoms
  • MRI is the investigation of choice if symptoms persist
Feature Cervical Radiculopathy Cervical Myelopathy
🧬 Pathophysiology Compression of a nerve root Compression of the spinal cord itself
🔍 Anatomy involved Exiting cervical nerve root (e.g. C6, C7) Cervical spinal cord (central canal stenosis)
👤 Typical patient Younger adults with disc herniation, or spondylosis Older adults with degenerative cervical stenosis
⚡ Symptoms Unilateral pain, tingling, numbness in a dermatome Bilateral symptoms, clumsy hands, gait disturbance
💪 Motor findings Weakness in specific myotome Weakness + spasticity below the level of compression
🦶 Reflexes Decreased reflexes at affected level (LMN signs) Hyperreflexia, positive Babinski, Hoffmann (UMN)
🧪 Special tests Positive Spurling’s test Positive Lhermitte’s sign, gait abnormalities
🔬 Diagnosis MRI cervical spine (nerve root compression) MRI cervical spine (cord compression, signal change)
💊 Management Often conservative; surgery if progressive Usually requires surgical decompression

      

🔗 Useful Links and References