Focused examination for cervical radiculopathy including Spurling's test, dermatomal assessment, and differentiation from other causes of upper limb symptoms.
Cervical radiculopathy examination requires precise dermatomal assessment and specific provocative tests. Examiners expect you to perform Spurling's test correctly, know the key differentiating features between cervical nerve root levels, and understand the difference between radiculopathy (root compression) and myelopathy (cord compression).
High-Yield Exam Summary
Cervical Radiculopathy:
Common Causes:
Root vs Level:
Typical Presentation:
Aggravating Factors:
Relieving Factors:
| root | motor | sensory | reflex | discLevel |
|---|---|---|---|---|
| C5 | Deltoid, biceps | Lateral arm (badge area) | Biceps | C4-5 |
| C6 | Wrist extensors, brachioradialis | Lateral forearm, thumb, index | Brachioradialis | C5-6 |
| C7 | Triceps, wrist flexors, finger extensors | Middle finger | Triceps | C6-7 |
| C8 | Finger flexors, grip | Medial forearm, ring, little finger | Finger flexor | C7-T1 |
| T1 | Hand intrinsics | Medial arm | None reliable | T1-2 |
Quick Root Level Identification:
Cervical radiculopathy
Reproduction of radicular arm pain (not just neck pain)
Cervical radiculopathy (narrows foramen, compresses root)
Ability to detect true positives
Ability to exclude false positives
Spurling's Test Interpretation:
Cervical radiculopathy
Relief of radicular arm pain with arm overhead
Cervical radiculopathy (abduction reduces nerve root tension)
Ability to detect true positives
Ability to exclude false positives
Cervical radiculopathy
Relief of radicular arm symptoms
Cervical radiculopathy (distraction opens foramina)
Ability to detect true positives
Ability to exclude false positives
Neural tension (root/plexus/peripheral nerve)
Reproduction of arm symptoms, especially with contralateral neck flexion
Neural tension - positive in radiculopathy, brachial plexopathy, peripheral nerve entrapment
Ability to detect true positives
Ability to exclude false positives
C5 - Deltoid (shoulder abduction):
C6 - Wrist Extension:
C7 - Triceps (elbow extension):
C8 - Finger Flexion:
T1 - Intrinsics:
Technique:
Key Reflexes:
| Root | Reflex | Technique |
|---|---|---|
| C5/6 | Biceps | Tap biceps tendon in antecubital fossa |
| C6 | Brachioradialis | Tap radial styloid (supinator reflex) |
| C7 | Triceps | Tap triceps tendon above olecranon |
Grading:
Radiculopathy Pattern:
| feature | radiculopathy | myelopathy |
|---|---|---|
| Pattern | Unilateral, single root | Bilateral, below lesion level |
| Reflexes | Decreased at affected level | Increased below lesion |
| Motor | LMN (weakness, atrophy) | UMN (spasticity, weakness) |
| Sensory | Dermatomal (arm only) | May include legs |
| Pathological Signs | Absent | Hoffman's +, Babinski +, clonus |
| Gait | Normal | Spastic, ataxic |
| Bowel/Bladder | Normal | May be affected (late) |
Myelopathy Signs (Upper Motor Neuron): Always test for these to exclude cord compression:
| condition | distribution | tests | exam |
|---|---|---|---|
| Cervical Radiculopathy | Dermatomal | Spurling's +, motor/sensory deficit | LMN signs at level |
| Cervical Myelopathy | Below lesion level | Hoffman's +, hyperreflexia | UMN signs |
| Brachial Plexopathy | Multisegmental (trunk/cord) | ULTT +, no neck signs | Non-dermatomal |
| Carpal Tunnel | Median nerve (hand) | Phalen's +, Tinel's + | Thenar weakness |
| Cubital Tunnel | Ulnar nerve | Elbow flexion test + | Intrinsic weakness |
| Thoracic Outlet | Variable (usually ulnar) | Roos test + | Vascular/neural |
| Rotator Cuff | Shoulder/deltoid | Impingement tests + | Shoulder ROM/strength |
"48-year-old office worker with 4-week history of right neck and arm pain radiating to the thumb and index finger, with numbness in these digits."
High-Yield Exam Summary