Transcript Cervical-Radiculopathy-Handoutx

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
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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
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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 612 weeks trial
– Progressive neurological
deficit
• Epidural Steroid injection
• Anterior decompression
and fusion
• Discectomy with or without
fusion
• Posterior
laminoforaminotomy
• Facetectomy