What is Cervical Radiculopathy?
Assessment should include neck and upper limb range of motion, strength, and sensation as well as neural provocation testing.
This condition may arise in any population but is most common in people in their 40s or 50s and in men more than women and people with a history of previous cervical or lumbar radiculopathies, smoking, and regular heavy lifting (Iyer and Kim, 2016). Cervical radiculopathy may be caused by cervical disc herniation, osteophyte formation, spondylosis of the facet joint, instability, or trauma and most commonly effects the C7 root with C6 and C8 roots next most respectively (Iyer and Kim, 2016) (Caridi et al, 2011).
Differential Diagnosis
There is overlap in the presentation of C6 radiculopathy and carpal tunnel syndrome however there are a few ways to differentiate (Caridi et al, 2011). Carpal tunnel is more likely to have pains indicating a more inflammatory response rather than mechanical and will come with significant weakness and/or atrophy in the thenar muscles (Caridi et al, 2011). C6 radiculopathy however will likely not have the same pain and it innervates there would be an equal effect in elbow flexor and wrist extensor symptoms and less local to the thumb (Caridi et al, 2011).
Similarly, C8 tendinopathy is often mistaken for ulnar neuropathy as they both affect the inferior medial aspect of the arm into the fourth and fifth digit (Caridi et al, 2011). The same differentiators apply to c8 Radiculopathy and ulnar neuropathy and Sperling’s test can be used to positively diagnose cervical radiculopathy while Tinel’s test can be used to confirm carpal tunnel or ulnar neuropathy (Caridi et al, 2011).
Treatment for Cervical Radiculopathy
Physiotherapy is the first-line treatment for cervical radiculopathy. Manual therapy has been shown to be effective in reducing pain while increasing active range of motion and overall function (Boyles et al, 2011). Exercises including neural sliders (Boyles et al, 2011) and strength-based programs of the neck, chest, and shoulders have been shown to be effective as well (Iyer and Kim, 2016).
If physiotherapy does not sufficiently help the patients then medications and corticosteroids can be effective and failing that, surgical options exist such as microdiscectomy, cervical disc arthroplasty, and posterior decompression (Iyer and Kim, 2016).
References
Boyles, R., Toy, P., Mellon, J., Hayes, M., & Hammer, B. (2011). Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. Journal of Manual & Manipulative Therapy, 19(3), 135-142.
Caridi, J. M., Pumberger, M., & Hughes, A. P. (2011). Cervical radiculopathy: a review. HSS Journal®, 7(3), 265-272.
Iyer, S., & Kim, H. J. (2016). Cervical radiculopathy. Current reviews in musculoskeletal medicine, 9(3), 272-280.