Cervical Disc (with Radiculopathy)
Cervical
Disc (with Radiculopathy)
Overview
In a case
such as this, the symptoms suggest a definite protrusion of nuclear material
from the disc, which is affecting a cervical nerve root or roots. The patient's
symptoms are usually more severe in the arm than in the neck, although pain may
be equally divided between both areas; in very rare cases the neck may be more
painful than the arm. The patient's symptoms are often quite severe and muscle
spasms may spread discomfort throughout a large area of the upper back, a factor
that can often be misleading during the assessment.
Subjective
Findings
Onset The patient
is usually between 35 and 55 years of age. Onset is most often sudden with no
known cause. In many cases the patient will state that he woke with the pain in
the morning or that it started very soon after rising (9, 18, 20).
Duration The severity
of the symptoms and the fact that they are functionally very limiting often
means that the patient is seen within a matter of days following onset of the
condition.
Frequency It is common
for a patient to have a history of previous neck problems, often with no arm
symptoms or with only minor symptoms compared to the present episode. In all
likelihood this is the first time the patient will have experienced these
particular symptoms.
.
Area of
Symptoms
are felt throughout the cervical region, but will be far worse on one side.
Symptoms in the arm will be unilateral in distribution and can be felt anywhere
from the shoulder to the fingers. Symptoms are also often felt around and over
the scapula on the affected side. The distribution of the arm symptoms will
often be specific to the area supplied by the affected nerve root and can then
in themselves be diagnostic.
Type of
Symptoms
Sharp pain is usually felt in the neck and arm, and the neck and shoulder
girdle will often be stiff, most particularly on the affected side. An array of
symptoms may be felt in the arm, with paranesthesia and numbness being the most
common. Arm symptoms will often be localized to a specific dermatome, in severe
cases loss of muscle strength may be found in specific muscles (myotomes).
Miscellaneous The patient
may in some cases be found sitting in the waiting room with his forearm resting
on his head, having found that this relieves the arm symptoms when they are due
to pressure on a nerve root (usually C 5-6).
Objective
Findings
Observation The patient
often presents with the neck held in either a degree of flexion or side flexion
away from the affected side or a combination of the two. lateral shift of the
spine away from the affected side may be observed when viewing the patient from
the rear.
Active
Movements
In this condition there is usually one movement that is not only pain-free, but
that also tends to relieve either the arm symptoms, the neck symptoms, or both.
Most commonly this is side flexion away from the affected side, and less
commonly it can be rotation away from the affected side. Side flexion to the
affected side is usually limited and produces an immediate increase in both neck
and arm symptoms. Flexion and extension will both be limited, with either one
or both of these movements producing neck and arm symptoms. Rotation to the
affected side may also exacerbate neck and arm symptoms, but is usually less of
a problem than the other movements described.
Passive
Movements
The same pattern of restriction will be found on passive testing as found on
active movements. A springy block may be noted at the end range of either
flexion or rotation to the affected side. A solid block or muscle spasm may be
elicited on side flexion to the affected side.
Resisted
Movements
Isometric testing of the cervical spine and shoulder girdle does not usually
produce any noticeable symptoms, although resisted flexion of the cervical the spine may produce discomfort in the neck, particularly when resistance is
strongly applied.
Palpation There are
often various tender points to be found in the sides of the cervical spine
bilaterally and in the upper trapezius and around the medial border of the
scapula on the affected side. Loss of sensation may be found in the arm,
usually over the site of a specific dermatome.
Specific
Tests
The patient may have decreased or absent reflexes at the elbow or wrist.
Brachial plexus tension tests may be positive and Dural signs may also be
present.
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