C6 Radiculopathy

• Patients with sensory changes in the thumb and index finger may have carpal tunnel syndrome and not a C6 radiculopathy.

• Check for a local Tinel's and Phalen's sign.

• An incomplete cervical spine exam in a patient with upper extremity problems often leads to an incorrect diagnosis.

• A full cervical spine x-ray series should be used to see on oblique films encroachment on the foramina by osteophytes.

Diagnostic Studies

Radiographs taken included an anteroposterior, lateral, obliques, and flexion/extension laterals of the cervical spine. There is evidence of multilevel degenerative changes, with principal changes at the C5-C6 level. These changes include loss of C5-6 disk height on the lateral and narrowing of the C6 neural foramen with encroachment on the foramina by osteophyte on the oblique views (Fig. 18—1). Magnetic resonance imaging (MRI) of the cervical spine showed evidence of multilevel mild cord impingement with disk herniation at C3-4, C4—5, C5—6, and C6—7, along with focal increased signal intensity within the cord at the C5—6 level on the T2-weighted images consistent with cord edema (Fig. 18—2). There is also bilateral foraminal narrowing on the axial images at the C5—6 level (not shown). A needle electromyogram (EMG) was performed, which showed membrane instability of the C6 innervated muscles on the right side. C5, C7, and C8 muscles were normal. The nerve conduction studies did not exhibit peripheral nerve slowing as evidence for peripheral nerve compression.

Ray Fracture
Figure 18—1. (A) Lateral radiograph of the cervical spine showing multilevel degenerative changes with narrowing at the C5—6 disk space. (B) Oblique radiograph showing narrowing and osteophyte (4) formation within the C5—6 neuroforamen.
Taenia Solium Cervicales

Figure 18—2. T2-weighted sagittal magnetic resonance imaging (MRI) ofthe cervical spine shows disk herniations at C3 lumen 4, C4—5, C5-6, and C6-7, along with focal increased signal intensity within the cord at the C5—6 level on the images consistent with cord edema.

Differential Diagnosis

Carpal tunnel syndrome Rotator cuff tear C5 radiculopathy C6 radiculopathy Brachial neuritis Thoracic outlet syndrome

Diagnosis

C6 Radiculopathy

Cervical radiculopathy represents impingement of an exiting cervical nerve root generally caused by herniated disk material or from degenerative cervical spondylosis, or commonly a combination of the two. In cases where the etiology is a herniated disk, the symptoms are more acute in onset and may be exacerbated by coughing or other Valsalva-type maneuvers. Cervical spondylosis as a cause for radiculopathy has an insidious onset, with degenerative changes occurring at the disk and the zygapophyseal and neurocentral joints (Fig. 18—3). Other causes of cervical root irritation or compression include intraspinal tumors, infection, inflammatory arthritic changes, and chemical irritation from neurohumeral factors.

The presentation of cervical radiculopathy begins with varying degrees of pain, paresthesias, and motor weakness in the neck and upper extremity. Significant neck pain is often associated with the radicular pain and sensory changes, which generally follow a dermatomal distribution. Breast pain and angina-like symptoms should also be considered as potential radicular complaints. Weakness and reflex changes are also root specific, but significant overlap exists in the muscular innervation of the upper extremity and may occasionally be confusing. Table 18—1 outlines the clinical symptoms and findings seen with individual root involvement, and other potential causes for similar findings.

Cervical nerve root

Articular process (facet joint)

Intervertebral foramina

(neuroforamen)

Cervical nerve root

Articular process (facet joint)

Intervertebral foramina

(neuroforamen)

Cervical Nerve Root Foramen

Figure 18—3. Axial anatomy ofthe cervical spine at the level of the disk and exiting nerve root at the intervertebral foramina. Note the disk herniation on the left side impinging the nerve root.

Vertebral body

Disk

Uncinate process (joint of Luschka)

Vertebral body

Disk

Uncinate process (joint of Luschka)

Figure 18—3. Axial anatomy ofthe cervical spine at the level of the disk and exiting nerve root at the intervertebral foramina. Note the disk herniation on the left side impinging the nerve root.

Table 18-1 Clinical Symptoms and Physical Findings Seen in Individuals with Cervical Root Involvement and Other Potential Causes for Similar Findings
Osteoarthritis

Osteoarthritis

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Responses

  • valdemar
    Can a herniation at c34 cause carpal tunnel symptoms?
    2 months ago

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