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Cervical Radiculopathy
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
When performing provocative tests, such as Spurling’s test (exacerbation of symptoms resulting from foraminal narrowing caused by simultaneous extension and rotation to the affected side, lateral bend and vertical compression reproducing symptoms in the ipsilateral arm), remember that these tests can be painful, and you must carefully watch out for any signs of patient discomfort and discontinue any examination that is causing pain to the patient. Causing unnecessary pain in a viva may well be a pass/fail component!
The neck
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The Spurling’s test The patient is instructed to rotate the neck to one side with the chin elevated and laterally flexed, a position in which neural foramina are narrowed: if ipsilateral upper limb pain and paraesthesia are reproduced with axial compression of the head, the test is positive and that would increase the suspicion of a disc prolapse with cervical root compression. In these cases, pain may be relieved by the patient abducting the arm overhead (the abduction relief sign).
The Neck
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Spurling’s test is helpful. The patient is instructed to rotate the neck to one side with the chin elevated: if this reproduces ipsilateral upper limb pain and paraesthesiae, it would increase the suspicion of a disc prolapse with cervical nerve root compression. Pain may be relieved by having the patient place the arm overhead (the abduction relief sign).
Cervical nerve root variant: report of two cases under the cervical endoscopy and review of clinical literature
Published in British Journal of Neurosurgery, 2023
Bin Sun, Changgui Shi, Huiqiao Wu, Ying Zhang, Nicholas Tsai, Zeng Xu, Xiao-Dong Wu, Wen Yuan
A 62-year-old woman presented with a 4-month history of neck pain and radiating pain in her right upper extremity. She had hypaesthesia in her right forearm, especially in the 3rd and 4th fingers. The muscle strength of right wrist extensors was 4/5. Spurling’s test and the neck distraction test were positive on the right and negative on the left. Conservative treatments with traction and NSAID drugs for 3 months did not help. Magnetic resonance imaging (MRI) and computed tomography (CT) scan showed hyperplasia of the right C6-7 luschka joint and foraminal stenosis. Oblique view of cervical spine X-ray also indicated C6-7 bony foraminal stenosis on the right (Figure 1). The Visual Analogue Scale-arm (VAS-arm) score was 9, VAS-neck score was 9 and modified Japanese Orthopaedic Association (mJOA) score was 14 preoperatively.
Cervical spine thrust and non-thrust mobilization for the management of recalcitrant C6 paresthesias associated with a cervical radiculopathy: a case report
Published in Physiotherapy Theory and Practice, 2022
Christopher R. Hagan,, Alexandra R. Anderson,
Upper limb neural provocation test (ULNPT) was performed using the modified median nerve test due to the patient’s irritability levels and unwillingness to move his shoulder into abduction overhead. The modified median neural provocation test (ULNPT2A) has established norms and similar reliability and diagnostic metrics compared to the standard median nerve provocation test (ULNPTA) (Schmid et al., 2009; Yaxley and Jull, 1991). With shoulder depression, external rotation, forearm supination, and wrist and finger extension, he reported an increase in hand tingling at 0° of shoulder abduction. Cervical lateral flexion to the right increased these symptoms indicating a positive test. Spurling’s test was performed by adding compression in L cervical lateral flexion and was positive for upper arm pain provocation. Distraction was performed in supine and was positive for reducing neck and shoulder pain.
Current concepts review: peripheral neuropathies of the shoulder in the young athlete
Published in The Physician and Sportsmedicine, 2020
Tamara S. John, Felicity Fishman, Melinda S. Sharkey, Cordelia W. Carter
As with any injury, physical examination of an athlete with a suspected stinger begins with inspection, with the examiner noting any areas of ecchymosis, swelling, asymmetry or deformity. The cervical spine, sternoclavicular joint, clavicle, acromioclavicular joint, shoulder, elbow, and hand are palpated. If there is no concern for cervical spine injury, active range of motion of the neck is assessed. Passive and active range of motion of the shoulder, elbow and wrist are assessed and compared to those of the contralateral upper extremity. Strength testing of the major muscle groups is performed bilaterally (Table 1), followed by a sensory examination and deep tendon reflexes. Provocative maneuvers designed to re-create symptoms of cervical radiculopathy, such as the Spurling’s test, may be positive in the athlete with a stinger. Serial examination is key for accurate assessment of the extent, duration, and resolution of symptoms.