Brief Summary
This video by Dr. Ebraheim discusses cervical radiculopathy, which is basically irritation of a cervical nerve root. He explains how to differentiate it from other conditions, especially shoulder problems, and how to identify the affected nerve root based on symptoms. He also talks about diagnosis, conservative treatment options, and when surgery becomes necessary. Key takeaways include understanding the C7 nerve root's role (middle finger numbness, triceps weakness), the importance of clinical tests like Spurling's and shoulder abduction, and the fact that most cases improve with non-operative treatment.
Cervical radiculopathy is basically when a nerve root in your neck gets irritated or compressed. This can cause pain and progressive neurological deficits. Conditions like disc herniations can irritate the nerve roots in the cervical spine. It's important to figure out if the problem is actually coming from the neck and not somewhere else, like the shoulder.
Shoulder problems and cervical spine issues can sometimes feel the same. If lifting your arm over your head (shoulder abduction) gives you relief, it's more likely a cervical problem. This is because it reduces tension on the nerve roots. Be careful with MRIs, especially if you're over 40, as they can sometimes show problems that aren't really causing your pain. Nerve conduction studies aren't super reliable. EMG and nerve studies can help tell the difference between radiculopathy and a nerve getting trapped somewhere else.
Disc problems in the neck usually affect the nerve root that's lower in number. For example, a C6-C7 disc herniation will likely affect the C7 nerve root. If you have numbness in your middle finger, think C7. Remember, C7 is the middle finger. C6 affects one way on the fingers, and C8 affects the other way.
With C7 nerve root involvement, you'll get numbness in the middle finger, weakness in your triceps, and your triceps reflex will be affected. There are 7 vertebrae in the cervical spine, but 8 nerve roots. The cervical nerve roots run horizontally. So, whether the disc herniation is in the center or off to the side, it'll affect the same nerve root. The C7 nerve root runs above the C7 pedicle.
For C7, think wrist flexion. The hand looks like a seven when you flex the wrist and extend the fingers. Wrist extension is C6. C5-C6 disc issues are the most common and compress the C6 nerve root. Finger flexion is C8. T1 is like a "black sheep". Shoulder abduction is C5, elbow flexion is C6, and elbow extension is C7 (and triceps reflex).
C6 dermatome is present at the lateral side, C7 is the middle finger, and C8 is the first finger. Patients usually have arm pain on one side that gets better when they lift their arm. They'll also have numbness and tingling in specific areas (dermatomes). They might also have pain between their shoulder blades or headaches.
When you check the patient, do provocative tests like Spurling's test and the shoulder abduction test. Spurling's test involves extending and rotating the neck towards the side that hurts. This narrows the space where the nerve exits and can bring on the symptoms. This test helps differentiate cervical radiculopathy from other nerve problems. The shoulder abduction test (lifting the arm) should relieve the pain if it's a cervical issue.
Make sure the patient doesn't have a "double crush" – a problem in the neck and another nerve issue somewhere else. Also, rule out myelopathy (spinal cord compression). Check for upper motor neuron signs like gait instability, Hoffman's sign, hyperreflexia, and clonus.
Even if the MRI looks bad, you'll usually start with conservative treatment for about 3 months. This includes therapy and anti-inflammatory meds. About 95% of patients get better without surgery. Cervical radiculopathy is usually treated without surgery, unlike cervical myelopathy.
Surgery is considered if the pain is really bad and doesn't improve after 6-12 weeks, or if there's progressive weakness or numbness. The surgery is usually done from the front (anteriorly) to directly remove whatever's pressing on the nerve, like a herniated disc or bone spurs. They might put in a bone graft or spacer to open up the space where the nerve exits, and then add a plate. Some surgeons might prefer to do the surgery from the back (posterior approach).
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Transcript
Full transcript of “Cervical Radiculopathy - Everything You Need To Know - Dr. Nabil Ebraheim”. Click a timestamp to open the video at that moment. Need another video? Use the YouTube transcript generator.
0:06 cervical radiculopathy cervical radiculopathy is i cervical nerve root pression the patient will have pain and all progressive neurological deficit that is all from conditions such as discrimination that irritate a nerve in the cervical spine so cervical radiculopathy is an irritation of the cervical nerve root we know that the cervical spine and shoulder problems overlap you know that the condition is of cervical etiology if relief of the pain who cares
0:52 with shoulder abduction by placing the hand over the head the relief of the symptoms or cares due to decreased tension on the nerve roots be aware of the false positive MRIs especially if the patient is above the age of 40 never conduction studies are not useful it has a high false negative rate mg and nervous studies may differentiate radiculopathy from peripheral nerve entrapment the cervical disc problems usually affect the lower numbered nerve root
1:37 such as c6 c7 herniation will affect c7 nerve root when you see the middle finger numbness then a tc7 just remember c7 in the middle finger if we see the middle finger in the test exam it is c7 one way on the fingers will be c6 go the other way will be c8 the middle finger is c7 we have c7 nerve root you will get the middle finger numbness you will get the triceps weakness and triceps reflex will
2:23 be affected is an easy way to remember the dermatomes and the muscle function but this understand arrangement of this nerve roots he got seven vertebrae but eight nerve roots so what happened the cervical nerve root is horizontal in orientation so doesn't matter if the desk is central or the desk is foraminal it will get the same nerve root for example if this is at the level of c6 c7 is gonna get c7 nerve root and this nerve root runs above the pedicle so c7 nerve root runs above c7 pedicle
3:11 he come to see eighth nerve root and this one runs above t1 pedicle and then T when their route runs below t1 pedicle so let's start with c7 c7 you'll have the rest flexion it looks like c7 and you can see that this is flexed and the finger is extended it is the shape of seven that will help you to remember that if the rest flexion is c7 then the rest extension is c6 c5 c6 is the most commonly affected desk and that will compress c6 nerve root
3:59 finger flexion is c8 a black ship is he won the entire CI is t1 you can add sugar abductor five and elbow flexion will be c6 elbow extension will be c7 and triceps reflects is c7 he can see the dermatomes
4:52 here see sets his present at the letter sex c7 is the middle finger and the first finger will be c8 so the patient will come to you with unilateral arm pain relieved by arm elevation and the numbness and the paresthesia will be in specific dermatomes vision we also have an Alberta is pain or inter scapular pain the patient may complain of Aksum haddock
5:41 when you examine the patient you would do the provocative tests such as the spelling and the shoulder abduction test the spelling test is done by extending and rotating the net towards the involved side it reproduces the symptoms by narrowing the neural foramen the spelling test different sheet cervical radiculopathy from peripheral nerve entrapment shoulder abduction test lifting the arm above the head relieves the symptoms a different she cervical pathology from other causes of painful shoulder
6:26 etiology make sure you don't have a double crush syndrome one in the neck and one in the peripheral nerve make surely different sheet with the colaba the--from my allowable thing make sure exclude the coexisting myelopathy to examine the patient for upper motor neuron signs or cervical myelopathy this is the patient for gate instability it's the half month sign de Pepin is key
7:13 and the clonus and check if you have hyperreflexia treatment even if they show you a bad cervical spine discs on an mi you will treat it conservatively for about three months you give the patient therapy and nonsteroidal anti-inflammatory medication ninety-five percent of the patient will improve with non-operative treatment cervical radiculopathy is generally treated non-operatively in contrast to cervical myelopathy
8:01 when do you do the surgery you do the surgery when there's a persistent severe pain for six to 12 weeks and all progressive neurological deficit such as weakness or numbness the procedure to treat cervical radiculopathy is usually done anteriorly with direct removal of the lesion that causes the radiculopathy such as herniated disc or expels when you placed anterior bone graft or data graft in the disk space you open the neural foramen and that will indirectly relieve the nerve then you
8:46 add the anterior plate some surgeons prefer posterior approach thank you very much I hope that was helpful you
