Review Question - QID 193

Foraminal stenosis at the C7/T1 level will affect the C8 nerve root.

A disc herniation at the C7/T1 level will most likely affect the C8 nerve root. C8 radiculopathy usually presents with sensory symptoms about the medial border of the forearm and hand, as well as finger flexion weakness (the C8 nerve root provides innervation to the flexor digitorum superficialis, flexor digitorum profundus (FDP), and flexor pollicis longus). It is important to differentiate a C8 radiculopathy from a peripheral ulnar neuropathy, which also presents with sensory symptoms in the ulnar hand and fingers. One way to do so is to test DIP flexion of the middle and index fingers. The function of the flexor digitorum profundus in the index and middle fingers can be affected by a C8 cervical radiculopathy, but they are not affected by ulnar nerve entrapment (the FDP of the index and middle fingers is supplied by the median nerve, specifically the anterior interosseous nerve).

Rao et al. review of the pathoanatomy of cervical spondylosis and the different clinical manifestations. They recommend a simplified clinical approach of dividing the presenting findings into the categories of axial neck pain, radiculopathy, myelopathy, or some combination of these three.

Hughes et al. provide a review article of cervical radiculopathy. They analyzed relevant PubMed articles and focused on pathophysiology, diagnosis, and treatment. They found that the most common cause of nerve root compression was degenerative facet joint hypertrophy and herniation of the intervertebral disc; most patients will improve with non-operative treatment.

Incorrect Answers:
Answer 1: This describes a C5 or axillary nerve palsy.
Answer 2: This describes a C7 palsy.
Answer 3: This describes a peripheral ulnar nerve palsy (a C8 radiculopathy would also involve flexion weakness of the long and index fingers).
Answer 5: This describes a myelopathic patient; this finding would be associated with central cord stenosis, not foraminal.