What are the key questions in the initial evaluation of cervical radiculopathy?

Updated: Oct 08, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Obtaining a detailed history is important to establish a diagnosis of cervical radiculopathy. The examiner should ask the following questions:

  • First, what is the patient's chief complaint (eg, pain, numbness, weakness, location of symptoms)?

    • A visual analogue scale from 0-10 can be used to determine the patient's perceived level of pain.

    • Anatomic pain drawings can also be helpful in giving the physician a quick review of the patient's pain pattern.

  • What activities and head positions increase or decrease symptoms?

    • This information can be helpful for both diagnosis and treatment.

  • When did the injury occur, what was the mechanism of injury, and what was done at that time?

  • Has the patient experienced previous episodes of similar symptoms or localized neck pain?

  • Does the patient have symptoms suggestive of a cervical myelopathy, such as changes in gait, bowel or bladder dysfunction, or lower-extremity sensory changes or weakness?

  • What previous treatments (prescribed or self-selected) has the patient tried? These may include:

    • The use of ice and/or heat

    • Medications (eg, acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs])

    • Physical therapy, traction, or manipulation

    • Injections

    • Surgical treatments.

  • A social history should include the patient's sport and position, occupation, and the use of nicotine and/or alcohol.

  • The typical patient with cervical radiculopathy presents with neck and arm discomfort of insidious onset. The discomfort can range from a dull ache to a severe burning pain. Typically, pain is referred to the medial border of the scapula, and the patient's chief complaint is shoulder pain. As the radiculopathy progresses, the pain radiates to the upper or lower arm and into the hand, along the sensory distribution of the nerve root that is involved.

  • The older patient may have had previous episodes of neck pain or give a history of having arthritis of the cervical spine.

  • Acute disc herniations and sudden narrowing of the neural foramen may also occur in injuries involving cervical extension, lateral bending, or rotation and axial loading. These patients complain of increased pain with neck positions that cause foraminal narrowing (eg, extension, lateral bending, or rotation toward the symptomatic side).

  • Many patients report that they can reduce their radicular symptoms by abducting their shoulder and placing their hand behind their head. This maneuver is thought to relieve symptoms by decreasing tension at the nerve root.

  • Patients may complain of sensory changes along the involved nerve root dermatome, which can include tingling, numbness, or loss of sensation.

  • Some patients may complain of motor weakness. A small percentage of patients will present with weakness only, without significant pain or sensory complaints.


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