Diagnosing Cervical Radiculopathy

Mature woman showing gp painful arm
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Cervical radiculopathy is a common cause of pain, pins, and needles and/or weakness in your arm, as well as neck pain and other symptoms. It is generally brought about when a spinal nerve root is compressed, either by an acute or chronic disc herniation or by degenerative changes in spinal structures. Examples of spondylosis, which is another name for degenerative changes in the spine, can include arthritis-related symptoms such as facet joint hypertrophy or bone spurs, or disc degeneration.

If you have cervical radiculopathy, you may find yourself in severe pain, particularly at first (in the first few weeks after onset). And you may also notice pins and needles (as mentioned above) or other nerve sensations in your forearm and hand.

Complicated, right? How does your doctor know what your symptoms mean, exactly? If it's not radiculopathy, then what is it? How can she know which spinal nerve root is the one causing your symptoms? And how important is this in the overall pain relief process?

If your symptoms are limited to pain only, this is called cervical radicular pain.

Making a Diagnosis

At your appointment, your doctor will likely take a history and give you a physical exam. The things you tell her about your felt symptoms will inform her about the pain pattern, which is an important step in the diagnostic process.

The manual exam will help your doctor identify the dermatomes and/or myotomes in which your symptoms are located.

This information helps her determine which spinal nerve root is being compressed or irritated. A diagnostic imaging test (for example, an MRI) is generally not considered necessary, except in special circumstances (discussed below). 

Symptoms That Flag a Possible Cervical Radiculopathy Diagnosis

Doctors generally entertain a diagnosis of cervical radiculopathy when you present with arm pain, neck pain, pain in or around your scapula (shoulder blade) bone.

Other sensory symptoms that serve as a flag to your doctor about the possibility of cervical radiculopathy include the pins and needles discussed above along with sensory changes in your arm such as numbness.

Motor symptoms that may alert your doctor include arm weakness and/or abnormal deep tendon reflexes in your arm. Weakness in your deltoid muscle (which is the cap-like muscle that surrounds your shoulder and upper arm), weakness in the intrinsic muscles of your hand, and/or scapular winging are also potential indications. Scapular winging is an inability of the medial (inner) inner border of the shoulder blade—otherwise known as your scapula bone—to lie flat on your ribs.

Still, other symptoms that may alert your doctor include chest or deep breast pain and/or headaches.

Once aware of the symptoms a patient has that correspond to cervical radiculopathy, many doctors confirm this diagnosis by means of a manual test known as Spurling's. A number of studies strongly suggest that Spurling's test—based on its specificity as a diagnostic measure—can definitively confirm the presence of cervical radiculopathy.

Although Spurling’s test (actually, a maneuver) is specific, it’s not very sensitive for diagnosing cervical radiculopathy because a test result that is negative (meaning the sign does not show up) does not rule out a diagnosis of cervical radiculopathy.

Just the same, the North American Spine Society says that Spurling's test, along with similar provocative tests, may be considered as part of the evaluation; unlike the pro-Spurling's test studies, however, the NASS stops short of asserting that a positive sign on a Spurling's test confirms the diagnosis.

Diagnostic Testing Before Surgery

If you plan to have surgery, and your cervical radiculopathy is due to arthritis or degenerative changes (spondylosis), your doctor will likely want to confirm by means of one or more diagnostic imaging tests the spinal level from which your symptoms arise.

The North American Spine Society says that just identifying the specific dermatome in which the pain, nerve sensations and/or motor weakness is experienced is not enough to make an accurate diagnosis of cervical radiculopathy.

For this reason, they recommend a computed tomography (CT scan), CT myelography (CTM) or an MRI (magnetic resonance imaging test) before undergoing spinal decompression surgery. Note that the NASS recommends these tests only after a course of conservative treatment proves unable to relieve symptoms.

The good news is that most cases of cervical radiculopathy resolve on their own or with physical therapy without the need for surgery.

Sources:

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Eubanks, J. D., Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. Am Fam Physician. 2010 Jan 1;81(1):33-40.

Kuijper B. [Cervical radiculopathy]. Ned Tijdschr Tandheelkd. 2014 Oct;121(10):483-6. doi: 10.5177/ntvt.2014.10.14134.

North American Spine Society (NASS). Diagnosis and treatment of cervical radiculopathy from degenerative disorders. Burr Ridge (IL): North American Spine Society (NASS); 2010. 179 p.

Ryan M., David E. Fish, David E. Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med. 2008 Mar.