ent in the neck, radial side of the biceps, and/or forearm, and motor deficits may be present in the wrist extensors and biceps. In addition, brachioradialis and bicep reflexes may be diminished. By contrast, carpal tunnel syndrome typically involves thenar mus - cle atrophy and can be reproduced with Tinel’s sign (Kang et al., 2020). C7 radiculopathy C7 is the most frequently occurring cervical radiculopathy and causes weakness in the triceps, wrist flexors, and finger extensors (Kang et al., 2020). Differential diagnosis includes posterior inter- osseous nerve entrapment, which can also cause finger extension weakness. However, with posterior interosseous nerve entrap- ment, the triceps and wrist flexors would have normal strength and there would not be any sensory changes (Kang et al., 2020). C8 radiculopathy C8 radiculopathy symptoms may present with certain characteris - tics in common with both cubital tunnel syndrome (or ulnar neu- ropathy) and Pancoast syndrome. With cubital tunnel syndrome, there is tenderness at the medial side of the elbow, hypothenar muscles and adductor pollicis weakness, and sensory changes in the hand and fourth and fifth fingers (Kang et al., 2020). With C8 radiculopathy, adductor pollicis muscle function is intact. The symptoms of Pancoast syndrome include weakness or incoordi- nation in the hand muscles, but they also include swelling in the upper arm and chest tightness. Self-Assessment Quiz Question #37 Typically, compression to the nerve root at a given cervical level manifests itself in predicable radicular symptoms, which can help with differential diagnosis. However, nerve root compres- sion at certain levels is uncommon, and motor deficits at this/ these levels may be hard to detect. Which level(s) is/are this/ these? a. C2–4. Case Study: Carl Cooper Client is a 34-year-old letter carrier who presents to physical ther- apy complaining of right-sided neck pain with numbness in his right hand. The client states that the neck pain started about three weeks ago, and the numbness in his hand started four or five days ago. The symptoms in his hand come on when he carries his mail bag on his right shoulder. The patient localizes pain and numb- ness to the thumb and index finger. Question What cervical spine level correlates with pain/numbness in this area? In addition, weakness in which upper extremity muscles correlates with this spine level? What reflexes correlate with this Pain and/or numbness in the thumb and index finger is consis - tent with involvement of the C6 nerve root. In addition, pain and numbness might be expected in the lateral forearm. Weakness may be present in the biceps (elbow flexion, forearm supinators) and wrist extensors. Finally, the biceps and brachioradialis reflex - es may be affected (hypoactive). Special tests to confirm cervical radiculopathy spine level? Discussion Childress et al. (2016) outline three special test to confirm diag- nosis of cervical radiculopathy: Spurling test, shoulder abduction test, and upper limb tension test. Spurling’s test has been shown to be highly specific and sensitive in diagnosing cervical radiculopathy, as confirmed by magnetic resonance imaging (MRI) and electrodiagnostic findings (Chil- dress et al., 2016). For this test, the patient is seated, and the assessor side bends the neck toward the affected side then ap- b. C5. c. C6. d. C7.
neural compression, local ischemia, and inflammation. Symptoms related to neural compression are mediated by biochemical and immunological factors that, in turn, contribute to the pain and pathophysiology of radiculopathy (Taso et al., 2020). Differential diagnosis for cervical radiculopathy Diagnosis of radiculopathy involves assessment of upper extrem- ity pain, sensation, and strength. Pain is the most common symp- tom with cervical radiculopathy, followed by paresthesia; only about 15% of patients report weakness. Upper extremity reflexes should also be tested. Each nerve root level has a specific pattern of pain, weakness, and reflex changes. Nerve Root Pain Weakness Reflex Changes C2-C4 Occiput, Diaphragm. --
temporal area, back of the ear, upper neck. Neck, suprascapular, lateral upper arm to elbow. Neck, lateral forearm, thumb and index finger. Lower neck, intrascapular, posterior forearm, middle finger. Inter- and infrascapular, medial forearm, fourth and fifth finger.
C5
Shoulder abduction, external rotation, elbow flexion. Elbow flexion, forearm supination, wrist extension. Elbow extension, forearm pronation, wrist flexion, finger extension. Hand intrinsic, finger flexion.
Biceps.
C6
Biceps, brachioradialis.
C7
Triceps.
C8
C2–C4 radiculopathy Radiculopathy is not common at cervical spine levels 2 through 4, and motor deficits may be hard to detect (Kang et al., 2020). The C3 and C4 roots innervate the diaphragm, so radiculopathy at these levels can lead to diaphragmatic weakness and a pat- tern of breathing referred to as paradoxical respiration (Kang et al., 2020). In addition, differentiating pain in the head caused by radiculopathy at these levels from migraine may be indicated. For migraine headaches, differentiating symptoms include bitempo- ral throbbing pain, aura (sensitivity to light), nausea and vomiting, and visual disturbance (Kang et al., 2020). C5 radiculopathy C5 radiculopathy leads to symptoms similar to a rotator cuff tear (Kang et al., 2020). Both these conditions can cause weakness with shoulder abduction. However, C5 radiculopathy can be differenti- ated by determining if there is pain with resistance to shoulder abduction and/or tenderness in the rotator cuff, as these symp- toms are not typically present with C5 radiculopathy. In addition, reflexes would be intact with a rotator cuff tear. Another condition that may mimic C5 radicular symptoms is acute brachial plexus neuritis (Parsonage–Turner syndrome). This condition is character- ized by acute onset of pain in the neck, shoulder, and arm, which is followed by marked numbness and weakness of the arm within a few days to weeks (Kang et al., 2020). By contrast, pain and neurologic deficits occur simultaneously in cervical radiculopathy
(Kang et al., 2020). C6 radiculopathy
C6 radiculopathy symptoms are similar to carpal tunnel symp- toms. Both conditions can create weakness and numbness in the hand. However, with C6 radiculopathy, pain is also typically pres-
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