Ortho Dx: Radiating Neck Pain of Unknown Origin - Clinical Advisor

Ortho Dx: Radiating Neck Pain of Unknown Origin

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  • Figure. Magnetic resonance imaging of the cervical spine.

A 47-year-old man presents with a 2-month history of pain in his neck that radiates to the posterior left shoulder and arm. He denies any previous injury or precipitating event. His symptoms are intensified while driving and at night. Recent radiographs of the neck and shoulder are normal. Sagittal magnetic resonance imaging (MRI) of the cervical spine is obtained (Figure) and shows cervical disc herniations at C4-C5 and C5-C6 with cord contact and nerve root impingement.

Cervical radiculopathy is a condition that causes unilateral arm pain as a result of nerve root impingement.  Nerve root impingement may be caused by bony narrowing of the neuroforamen or by cervical disc herniation. Bony entrapment is associated with cervical...

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Cervical radiculopathy is a condition that causes unilateral arm pain as a result of nerve root impingement.  Nerve root impingement may be caused by bony narrowing of the neuroforamen or by cervical disc herniation. Bony entrapment is associated with cervical spondylosis and is most commonly found in patients >50 years of age, whereas cervical disc herniation is more common in patients aged 30 to 50 years.1

Cervical radiculopathy has a similar presentation to other shoulder disorders and differentiating this condition from others can be difficult. The most common symptom of cervical radiculopathy is arm pain; other symptoms include sensory loss to pinprick, neck pain, and diminished reflexes and strength of the arm. Nearly half of patients with cervical radiculopathy will experience arm pain in a nondermatomal distribution, which can make the diagnosis unclear.2

A positive shoulder abduction sign, or relief of radicular pain by holding the arm overhead, is noted with cervical radiculopathy. However, arm abduction generally causes increased pain when there is shoulder pathology involved.1 The Spurling test involves placing the patient’s neck in extension and bending the neck to the painful side. This further compresses the nerve in the neck and makes the radicular symptoms worse.1 The shoulder abduction sign and the Spurling test are the most frequently used physical examination maneuvers to help distinguish between cervical and shoulder pathology.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.

References

1. Sharrak S, Al Khalili Y. Cervical disc herniation. In: StatPearls [Internet]. StatPearls Publishing; 2020. Accessed June 30, 2020.

2. Grimm BD, Laxer EB, Patt JC, Darden BV. Mimickers of cervical radiculopathy. JBJS Rev. 2014;2(11):01874474-201411000-00001.

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