Magnetic resonance imaging (MRI) is the preferred modality for evaluating radiculopathies. Poor visualization of soft tissue makes CT less effective outside of this setting. Ĭomputed tomogram (CT) scanning may be helpful in the acute setting for diagnosing traumatic injuries resulting in radicular symptoms. Open mouth views are only necessary if disruption of the atlantoaxial joint is suspected. Oblique views may show foraminal narrowing at the level of radicular symptoms. Lateral views may show disc space narrowing. Plain x-ray studies of the cervical spine are commonly ordered for neck and upper extremity pain evaluation. In some cases, cervical traction can provide relief of radicular pain. The test is positive if the pain radiates down the upper limb of the ipsilateral side of the rotation. With the head extended, the head should then be rotated. The spurling test, which compresses the foramina, helps diagnose likely radiculopathy. Reduced muscle strength, innervated by the affected nerve, is a significant physical sign. If there is nerve impingement, the affected side is reduced relative to the unaffected side. Given the individual variation in deep tendon reflexes, comparing both sides of the neck is more important than overall magnitude. This helps accurately assess the patient's overall reflex response. When performing a physical examination, it is crucial to position the patient in a way that allows for the isolation of individual reflex arcs. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging, especially in cases of trauma. The history of patients with a complaint of radicular pain or muscle weakness should include inquiries about occupational risk factors, history of trauma, and pain patterns. Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted.
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