1.  Cervical Radiculopathy Kyle Christakos, David Cohee, Wade Dowling, Paul James, Levi Street, Stanton Urling

2. Pathophysiology  Cervical radiculopathy is a neurological condition characterized by dysfunction of a cervical spinal nerve, the roots of the nerve, or both.  Nerve root compression does not always lead to pain, unless dorsal-root ganglion is also compressed.  Hypoxia of nerve root and dorsal-root ganglion can aggravate effect of compression.  Inflammatory mediators released by cervical herniated intervertebral disks:  Matrix metalloproteinases  Prostaglandin E 2  Interleukin-6  Nitric oxide

3. Causes  Most common cause (70 – 75%) is foraminal encroachment of spinal nerve due to a combination of factors such as:  Decreased disc height  Degenerative changes of uncovertebral joints anteriorly  Zygapophysial joint posteriorly  Herniation of nucleus pulposus  Tumors of spine  Infection

4. Signs and Symptoms  Pain in the neck and one arm with a combination of:  Sensory loss  Loss of motor function  Reflex changes in affected nerve-root distribution  Burning, tingling, or both in a dermatomal distribution

5. Tests and Measures  Spurling’s Test  Upper Limb Tension Test – 1 (ULTT-1)  Sensory Testing  Light touch/pain/kinesthsia  MMT  DTR’s

6. How to Proceed  If patient presents with or has recent medical history of the following, than refer out to physician immediately:  Fever  Chills  Unexplained weight loss  Unremitting night pain  Immunosupresion  IV drug use  If patient does not have any of the previously mentioned symptoms, than treat impairments and continue to monitor.

7. References  Carette, Simon,M.D., M.Phil, Fehlings, Michael G,M.D., PhD. Cervical radiculopathy. N Engl J Med. 2005;353(4):392-399.