Monday, May 12, 2008

Differential diagnosis of cervical radiculopathy

1) Peripheral nerve entrapment (eg CTS)- see positive Phalen's and Tinel's sign, typical distribution, abnormal nerve conduction studies v. normal in cervical radiculopathy

2)Rotator cuff abnormal-- pain in shoulder or arm, rarely below elbow, worse with shoulder movements, normal sensation and reflexes.

3) Acute brachial plexitis-- (Parsonage Turner)-- see pain in neck shoulder and arm followed within days to weeks by weakness especially in C5-6 region as pain recedes (whereas in radiculopathy pain and weakness coincide).

4) Thoracic outlet syndrome-- Pain in shoulder and arm, intermittent paresthesia, C8-T1 symptoms (rare in radiculopathy), reproduction with provocative tests including Roo's test (rapid flexion and extension of fingers with arms abducted at 90 degrees and externally rotated 90 degrees), normal neuro exam, decreased radial pulse with vascular compression (rare) and usually normal NCS.

5) Herpes zoster-- neuropathic pain in dermatomal distribution followed by vesicular rash.

6) Pancoast syndrome-- Pain in shoulder/arm due to plexus compression, paresthesia is in C8-T1 distribution (intrinsic hand muscles), ipsilateral ptosis, miosis, and anhidrosis.

7) Sympathetic mediated syndromes-- pain and burning in arm with swelling, hyperesthesisa, allodynia, and vasomotor changes (temperature and color) with normal neurologic examination.

8) Referred somatic pain from neck-- such as discs, joints, usually segmental C5-6 felt in posterior neck and supraspinatus fossa, normal neuro exam.

9) SUNCT/SUNA syndromes with pain in cervical region

1 comment:

DrJamesStoxen said...

There are non surgical treatments for thoracic outlet syndrome that work very well. Here is a presentation I did on that very subject at the 12th Annual World Congress on Anti-aging Medicine, Mandalay Bay Hotel and Casino, Las Vegas Nevada, December 4, 2004

Presentation on Thoracic Outlet Syndrome
by Dr James Stoxen DC