Which clinical history findings are characteristic of cervical disc disease?

Updated: Apr 16, 2020
  • Author: Michael B Furman, MD, MS; Chief Editor: Dean H Hommer, MD  more...
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Answer

Discogenic pain without nerve root involvement is typically vague, diffuse and distributed axially.

Pain referred from disc to upper limb usually is nondermatomal, and does not follow any predictable course

In a study using provocative discography for symptom mapping, Slipman et al showed that unilateral symptoms were found just as often as bilateral symptoms. Slight variation was noted for referred somatic pain originating from each disc level to the neck, shoulder, and upper thoracic region but with a great amount of overlap. [23]

Activities that increase intradiscal pressure (eg, lifting, Valsalva maneuver) intensify symptoms. Conversely, lying supine provides relief by decreasing intradiscal pressure.

Vibrational stress from driving can also exacerbate discogenic pain. Yates et al showed that vibration and shock loading provided sufficient mechanical injury to exacerbate preexisting herniations, whereas a flexed posture did not influence the distance of nucleus pulposus tracking. [24]

Depending on whether primarily motor or sensory involvement is present, radicular pain is deep, dull, and achy or sharp, burning, and electric. Such radicular pain follows a dermatomal or myotomal pattern into the upper limb. Cervical radicular pain most commonly radiates to the interscapular region, although pain can be referred to the occiput, shoulder, or arm as well. Neck pain does not necessarily accompany radiculopathy and frequently is absent.

Patients may present with distal limb numbness and proximal weakness in addition to pain. Atrophy may be present.

A study has demonstrated cervical HNP-induced thermal changes (ie, thermatomes) in specific upper extremity distributions.

Mechanical stimulation of cervical nerve roots has shown that the distribution of referred radicular symptoms (ie, dynatome) may be different from sensory deficits outlined by traditional dermatomal maps.


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