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114: CERVICAL RADICULOPATHY

Eric J. Chaconas, DPT, PT, FAAOMPT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Herniated intervertebral disk

  • Prolapsed intervertebral disk

  • Slipped disk

  • Ruptured disk

  • Herniated nucleus pulposus

ICD-9-CM CODES

  • 719.48 Pain in joint involving other specified sites

  • 721.1 Cervical spondylosis with myelopathy

  • 722.0 Displacement of cervical intervertebral disc without myelopathy

  • 722.4 Degeneration of cervical intervertebral disc

  • 722.71 Intervertebral disc disorder with myelopathy cervical region

ICD-10-CM CODES

  • M47.12 Other spondylosis with myelopathy, cervical region

  • M50.00 Cervical disc disorder with myelopathy, unspecified cervical region

  • M50.30 Other cervical disc degeneration, unspecified cervical region

PREFERRED PRACTICE PATTERN

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1

PATIENT PRESENTATION

A 57-year-old female presents with reports of left-sided neck, shoulder, and arm pain persisting for the past eight months. She does not recall a specific injury and reports a gradual onset of pain. Symptoms are described as aching with burning and numbness into the arm and hand. She works as a medical billing specialist and reports increased symptoms after sitting at her desk for over an hour and driving her car for extended periods of time. Cervical left side bending and rotation movements increase arm pain and manual distraction provides symptom relief. Significant forward-head posture is noted along with weakness of the bilateral rhomboids, middle trapezius and serratus anterior. Diminished sensation is noted over the left thumb along with weakness of the left wrist extensors.

KEY FEATURES

Description

  • Any disorder that affects the spinal nerve roots

  • Lateral cervical spine nerve root compression

  • Gradual or acute onset secondary to intervertebral disc or osteophyte formation in the intervertebral foramen1

FIGURE 114-1

Cervical Radiculopathy. This is the classic position of relief for cervical radicular pain. This patient presented with severe pain in the neck with radiation to the extremity. The only way the patient was able to get relief was by holding his arm over his head in the position shown. This patient has a C5 to C6 herniated nucleus pulposus. (From Knoop KJ, Stack LB, Storrow AB, Thurman RJ. The Atlas of Emergency Medicine. 3rd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved. Photo contributor: Kevin J. Knoop, MD, MS.)

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Essentials of Diagnosis

  • Diagnosis made by clinical examination

  • Dermatome or myotome pattern

  • Reproduction of symptoms

General Considerations

  • Herniated disk is one cause

  • Avoid positions that increase symptoms

Demographics

  • Women at greater risk than men, middle-aged to geriatric

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Neck, shoulder, upper-extremity pain, and parasthesia often radiating to ...

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