Anatomy Msk · Year 1 · from Anatomy Msk
Case 3: Cervical Radiculopathy from Foraminal Stenosis
Clinical Image
Source: Wikimedia Commons - Cervical Spine MRI - CC BY-SA 3.0
Case Presentation
A 55-year-old accountant presents with 2 months of progressive right-sided neck pain radiating into her shoulder, lateral arm, and into her thumb and index finger. The pain is described as sharp and burning, worse when tilting her head to the right or looking up. She reports numbness in her thumb and weakness when trying to flex her elbow and turn her palm up. She works at a computer and has noticed difficulty with fine motor tasks. Physical examination reveals limited cervical extension and right lateral rotation due to pain. Spurling test (cervical extension with lateral rotation to the right and axial compression) reproduces her radicular symptoms. Neurological examination demonstrates weakness of right biceps and brachioradialis (4/5), decreased sensation over the lateral forearm, thumb, and index finger (C6 dermatome), and diminished biceps and brachioradialis reflexes. MRI of the cervical spine shows right-sided C5-C6 foraminal stenosis from uncovertebral joint hypertrophy and facet arthropathy causing C6 nerve root compression. She is started on gabapentin, referred for physical therapy with cervical traction, and scheduled for a cervical epidural steroid injection.
Key Learning Points
- Cervical spinal nerves exit above their corresponding vertebrae (C6 nerve exits at C5-C6 foramen)
- C6 radiculopathy causes biceps/brachioradialis weakness, decreased biceps reflex, and lateral forearm/thumb sensory loss
- The intervertebral foramen is bordered by the uncovertebral joint anteriorly and facet joint posteriorly
- Spurling test compresses the foramen and reproduces radicular symptoms in cervical radiculopathy
- Unlike lumbar disc herniations, cervical radiculopathy is more commonly caused by foraminal stenosis from arthritis