import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Cervical Radiculopathy Examination 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). ## Quick Reference One-Pager ## Pathophysiology **Cervical Radiculopathy:** - Compression or irritation of cervical nerve root - Causes unilateral arm pain in dermatomal distribution - Most common: C6 and C7 roots **Common Causes:** - Disc herniation (younger patients) - Foraminal stenosis (spondylosis, older patients) - Cervical disc-osteophyte complex **Root vs Level:** - Cervical nerve roots exit ABOVE their numbered vertebra - C6 root exits at C5-6 level (C5-6 disc affects C6 root) - C7 root exits at C6-7 level - Exception: C8 root exits at C7-T1 (no C8 vertebra) ## Clinical Assessment **Typical Presentation:** - Neck pain radiating to arm (in dermatomal pattern) - Pain worse with neck extension and rotation (narrows foramen) - Better with arm overhead (shoulder abduction relief) - May have numbness/tingling in specific distribution - Weakness in myotomal pattern **Aggravating Factors:** - Looking up (extension) - Rotating head toward affected side - Sneezing, coughing (Valsalva) - Reaching overhead (extension) **Relieving Factors:** - Arm overhead (abduction relief sign) - Neck flexion (opens foramina) - Neck distraction ## Neurological Examination by Root **Quick Root Level Identification:** - **C5**: "Military salute" - deltoid weakness - **C6**: Thumb and index "OK sign" + wrist extension - **C7**: Middle finger + triceps (most common) - **C8**: Grip weakness + medial hand/forearm - **T1**: Hand intrinsics (Froment's may be positive) ## Provocative Tests **Spurling's Test Interpretation:** - Highly SPECIFIC (positive test = likely radiculopathy) - Low sensitivity (negative test does NOT exclude radiculopathy) - Must reproduce ARM pain (not just neck pain) - Contraindicated if myelopathy, instability, or acute trauma suspected ## Motor Testing **C5 - Deltoid (shoulder abduction):** - Patient abducts arm against resistance - "Push up against my hand" **C6 - Wrist Extension:** - Patient extends wrist against resistance - "Cock your wrist back" - Also test biceps (elbow flexion) **C7 - Triceps (elbow extension):** - Patient extends elbow against resistance - "Push me away" - Also test finger extensors **C8 - Finger Flexion:** - Test grip strength - Patient makes fist while examiner tries to extend fingers - Also test FDP: Hold isolated DIP flexion **T1 - Intrinsics:** - Finger abduction (interossei) - "Spread your fingers" ## Reflex Testing **Technique:** - Patient relaxed, muscle in neutral tension - Tap tendon briskly with reflex hammer - Compare both sides **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:** - 0: Absent - 1+: Diminished - 2+: Normal - 3+: Brisk - 4+: Clonus **Radiculopathy Pattern:** - Hyporeflexia at affected level - Normal or increased reflexes below suggests myelopathy ## Differentiating Radiculopathy from Myelopathy **Myelopathy Signs (Upper Motor Neuron):** Always test for these to exclude cord compression: - **Hoffman's sign**: Flicking middle finger DIP → thumb/index flexion - **Inverted brachioradialis reflex**: Tap brachioradialis → finger flexion - **Hyperreflexia** in lower limbs - **Clonus** at ankles - **Babinski** (extensor plantar response) - **Gait disturbance** (spastic, unsteady) ## Differential Diagnosis ## Summary Presentation ## Examination Sequence 1. **Observation**: Posture, head position, muscle bulk 2. **Active ROM**: Flexion, extension, rotation, lateral flexion 3. **Spurling's test**: Extension + rotation + compression 4. **Shoulder abduction relief**: Hand on head 5. **Motor**: C5 (deltoid), C6 (wrist extension), C7 (triceps), C8 (grip), T1 (intrinsics) 6. **Sensory**: Dermatomal distribution 7. **Reflexes**: Biceps (C5/6), brachioradialis (C6), triceps (C7) 8. **Myelopathy screen**: Hoffman's, lower limb reflexes, gait 9. **ULTT**: If diagnosis unclear ## Examiner Tips