Cervical Radiculopathy Symptoms Diagnosis and Treatment скачать в хорошем качестве

Cervical Radiculopathy Symptoms Diagnosis and Treatment

Cervical radiculopathy is caused by cervical nerve root compression. The patient will have pain and/or progressive neurological deficits that result from conditions such as disc herniation that irritate a nerve in the cervical spine. So, cervical radiculopathy is an irritation of the cervical nerve root. We know that cervical spine and shoulder problems can overlap. You know that the condition is of cervical etiology if pain is relieved with shoulder abduction by placing the hand over the head. The relief of symptoms occurs due to decreased tension on the nerve roots. Be aware of false positive MRIs, especially in patients over the age of 40. Nerve conduction studies are not useful, as they have a high false negative rate. EMG and nerve studies may differentiate radiculopathy from peripheral nerve entrapment. Cervical disc problems usually affect the lower-numbered nerve root. For example, a C6–C7 herniation will affect the C7 nerve root. When you see middle finger numbness, then it is C7. Just remember: C7 is the middle finger. If you see the middle finger in a test exam, it is C7. Going one direction on the fingers will be C6; going the other way will be C8. The middle finger is C7. If you have C7 nerve root compression, you will get middle finger numbness, triceps weakness, and the triceps reflex will be affected. There's an easy way to remember the dermatomes and muscle functions, but let’s understand the arrangement of these nerve roots. You have seven cervical vertebrae, but eight cervical nerve roots. So what happens? The cervical nerve root is horizontal in orientation, so whether the disc herniation is central or foraminal, it will affect the same nerve root. For example, if the herniation is at the level of C6–C7, it will affect the C7 nerve root. This nerve root runs above the pedicle. So, the C7 nerve root runs above the C7 pedicle. The C8 nerve root runs above the T1 pedicle, and the T1 nerve root runs below the T1 pedicle. Let’s start with C7. C7 controls wrist flexion. It looks like a seven—you can see the wrist is flexed and the finger is extended. The shape of the seven helps you remember that. If wrist flexion is C7, then wrist extension is C6. C5–C6 is the most commonly affected disc, and that will compress the C6 nerve root. Finger flexion is C8. Finger abduction is T1. The interossei muscles are T1. You can add shoulder abduction as C5. Elbow flexion is C6. Elbow extension is C7. The triceps reflex is also C7. You can see the dermatomes: C6 is at the digit shaped like a 6, C7 is the middle finger, and the fifth finger is C8. The patient will present with unilateral arm pain relieved by arm elevation, and numbness and paresthesia in specific dermatomes. The patient may also have upper trapezius or interscapular pain. They may complain of occipital headache. When you examine the patient, you will perform provocative tests such as the Spurling test and the shoulder abduction test. The Spurling test is done by extending and rotating the neck towards the involved side. It reproduces symptoms by narrowing the neural foramen. The Spurling test helps differentiate cervical radiculopathy from peripheral nerve entrapment. The shoulder abduction test—lifting the arm above the head—relieves symptoms. It helps differentiate cervical pathology from other causes of shoulder pain. Make sure you rule out double crush syndrome—compression in both the cervical spine and peripheral nerve. Make sure you differentiate radiculopathy from myelopathy. Always exclude coexisting cervical myelopathy. Examine the patient for upper motor neuron signs. Test for gait instability. Check the Hoffmann sign, Babinski sign, and clonus. Also check for hyperreflexia. Treatment: Even if an MRI shows a significant cervical disc herniation, initial management should be conservative for about three months. Begin with physical therapy and nonsteroidal anti-inflammatory medications. Approximately 75% of patients will improve with nonoperative treatment. Cervical radiculopathy is generally treated nonoperatively, in contrast to cervical myelopathy. When do you perform surgery? Indications include persistent severe pain lasting six to twelve weeks and/or progressive neurological deficits such as weakness or numbness. The procedure to treat cervical radiculopathy is usually performed through an anterior approach, with direct removal of the lesion causing radiculopathy, such as a herniated disc or bone spurs. When you place the anterior bone graft or disc graft in the disc space, you open the neural foramen and that indirectly decompresses the nerve. Then, you add an anterior plate. Some surgeons prefer the posterior approach.