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Absent brachioradialis reflex
9%
110/1235
Thumb numbness/tingling
13%
164/1235
Weakness with wrist flexion
69%
847/1235
Weakness with shoulder abduction and external rotation
1%
18/1235
Decreased grip strength
7%
90/1235
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A C7 radiculopathy is indicated based on the MRI findings, which would cause weakness with wrist flexion, elbow extension and numbness over through the middle fingers of the hand. Cervical disc herniation can cause nerve root impingement, leading to cervical radiculopathy. Cervical nerve roots exit above their numbered pedicle (i.e. C7 root travels below C6 pedicle) and the level of nerve root compression is unchanged by a central or foraminal disc herniation, given the horizontal nature of the nerve root as it exits the cervical spine. C4-5 and C5-6 levels are most prone to degeneration, affecting the C5 and C6 nerve roots, respectively. When the C7 nerve root is impinged upon, elbow extension and wrist flexion are the primary motions that suffer from weakness, in addition to sensory loss in the 2nd-4th fingers and a diminished triceps reflex. Caridi et al. review the topic of cervical radiculopathy, including pathophysiology, diagnosis and treatment. They note that facet joint spondylosis and disc herniation are the most common causes of nerve root compression and diagnosis is based on physical examination and clinical imaging. They conclude that most patients improve significantly with nonoperative management, however, those with significant motor deficits or debilitating pain may require decompression. Iyer et al review the epidemiology, natural history and treatment of cervical radiculopathy. They reiterate the importance of physical examination and patient history in eliciting the diagnosis and find these things important in differentiating cervical radiculopathy from other non-radicular pathologies. They finish by discussing nonoperative management including physical therapy, steroid injections and lifestyle modifications or operative intervention with either anterior or posterior approaches used for decompression +/- fusion. Incorrect Answers: Answer 1: Absent brachioradialis reflex would be seen with C6 radiculopathy Answer 2: Thumb numbness & tingling would also be seen with a C6 radiculopathy Answer 4: Weakness with shoulder abduction and external rotation would be seen in a C5 radiculopathy Answer 5: Decreased grip strength would be seen in a C8 radiculopathy
4.3
(6)
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