How to Diagnose Acute Cervical Radiculopathy

A cervical radiculopathy can be a frightening and terribly painful condition. The problem, usually caused by pressure from a bulging or ruptured disc on nerves as they come out of the spinal cord, can also cause arm and shoulder weakness. Developing an idea about the anatomy of the neck, how nerves reach their destinations, and what different symptoms imply are all helpful in diagnosing this problem.

Difficulty: Moderate

Instructions

1. Learn about the anatomy of the neck, the spinal cord and the cervical spine from websites like orthogate.org. Develop an understanding of how the nerves to the arm come through openings in the cervical spine and go all the way to the fingers.

2. Know that pressure on these nerves cause various symptoms. The symptoms relate to what the nerves supply. Consequently, pressure on a nerve that supplies the outside of the left arm will seem to cause pain in the left arm even though the problem is in the neck.

3. Review your recent history. If you have symptoms that may be from a cervical radiculopathy, see if any activities that you may have been engaged in are related to the onset of your symptoms. For example, new or different exercises, injuries, change in jobs, or the lifting of a large weight. Stop any activities if they appear to be related to the onset of symptoms.

4. Rest and use anti-inflammatories. If your symptoms of pain do not resolve in 5 to 7 days, if numbness in either arm worsens, or if you notice ANY weakness in either arm, see your personal physician.

5. Begin your evaluation for a bulging or ruptured cervical disc or some other cause of pressure on nerves with plain x-rays of your neck and an exam by your doctor. These x-rays will not show discs, but they will show the cervical spine. Your personal physician may at this time refer you to a neurosurgeon or a neurologist.

6. Continue a workup with an MRI of the cervical area (if necessary). This shows cervical discs and nerves. If an MRI does not show a definitive cause for your symptoms, you may be sent for nerve conduction studies.

7. Complete your workup with a cervical myelogram only as a last resort. This test is an excellent visualization procedure, but is associated with some risk--the other tests are not.

Tips & Warnings

• There are basically three specialty areas that deal with cervical radiculopathies: neurosurgeons, surgeons who are trained in surgery on the brain and nerves; neurologists, internists who specialize in diseases of the brain and nerves (but do not do surgery); and orthopedic surgeons who specialize in the back and neck. Your personal physician will suggest one of these specialties depending upon the nature of your problem--do you obviously need surgery as in the case of muscular weakness and an obviously ruptured disc; could you have some sort of medical disease; or are there larger problems with your spine. Your doctor will also make the referral on the basis of which individual specialist he most trusts.
• Muscle weakness is a symptom that should send you to your doctor immediately. When a nerve supply to a muscle is compromised, the muscle atrophies. The sooner the nerve function is restored, the less chance there is that there will be any permanent loss of muscle.

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Resources

• Article that defines the anatomy of the neck and a cervical radiculopathy.
• Description of symptoms associated with a cervical radiculopathy.
• Synopsis of findings for ruptured or bulging disc at various levels.