What are the sensory exam findings in cervical radiculopathy?

Updated: Oct 08, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD  more...
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  • The sensory examination can be quite subjective because it requires a response by the patient.

  • In addition, patients with radiculopathy may have hyperesthesia to light touch and pin-prick examination.

  • On sensory examination, patients with a clear-cut radiculopathy should demonstrate a decrease in or loss of sensation in a dermatomal distribution.

  • Deep tendon reflexes

    • The deep tendon reflexes—or, more properly, muscle stretch reflexes, because the reflex occurs after a muscle is stretched (most commonly by tapping its distal tendon)—are helpful in the evaluation of patients who present with limb symptoms that are suggestive of a radiculopathy. The examiner must position the limb properly when obtaining these reflexes, and the patient needs to be as relaxed as possible. Any grade of reflex can be normal, so asymmetry of the reflexes is most helpful finding.

    • The biceps brachii reflex is obtained by tapping the distal tendon in the antecubital fossa. This reflex occurs at the C5-C6 level.

    • The brachioradialis reflex is obtained by tapping the radial aspect of the wrist. It is also a C5-C6 reflex

    • The triceps reflex can be obtained by tapping the distal tendon at the posterior aspect of the elbow, with the elbow relaxed at about 90° of flexion. This tests the C7-C8 nerve roots.

    • The pronator reflex can be helpful in differentiating C6 and C7 nerve root problems. If this reflex is abnormal in conjunction with an abnormal triceps reflex, then the level of involvement is more likely to be C7. The pronator reflex is performed by tapping the volar aspect of the distal radius with the forearm in a neutral position and the elbow flexed. This results in a stretch of the pronator teres, resulting in a reflex pronation.

    • In patients whose clinical picture raises concern about possible myelopathy, the lower-extremity reflexes and Hoffman and Babinski reflexes should also be assessed. Diffuse hyperreflexia and/or positive Hoffman and abnormal Babinski reflexes would indicate that the patient has a cervical myelopathy.

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