Lecture Final

Question 1

What is cervical radiculopathy?

Answer 1

Any process that causes irritation, compression, or dysfunction of one or more of the cervical nerve roots

Question 2

What is implied when there is a diagnosis of radiculopathy?

Answer 2

The presence of objective signs of nerve pathology (motor, sensory, reflex changes)

Question 3

What are the two major causes of true cervical radiculopathy?

Answer 3

1. Herniated cervical disc
2. Lateral canal stenosis

Question 4

What is the most common cause of cervical radiculopathy?

Answer 4

Herniated nucleus pulposus

Question 5

What is the definition of herniated nucleus pulposus?

Answer 5

A focal displacement of nuclear material outside the peripheral disc margin

Question 6

True or false: Nucleus pulposus herniation is less common in the cervical spine than in the lumbar spine

Answer 6

True

Question 7

What age group typically experiences nucleus pulposus herniations due to disc desiccation?

Answer 7

Patients under 40 years of age

Question 8

What is herniated nucleus pulposus often associated with?

Answer 8

Acute trauma

Question 9

What are the 4 stages/types of disc herniation?

Answer 9

1. Disc degeneration
2. Protrusion (also called prolapse or bulge)
3. Extrusion
4. Sequestration

Question 10

What is disc protrusion?

Answer 10

The disc protrudes into the spinal canal but the nucleus pulposus is contained within the annulus fibrosis

Question 11

What symptoms are associated with disc protrusion?

Answer 11

Often asymptomatic

Question 12

What is disc extrusion?

Answer 12

The nucleus pulposus leaks out through the annulus but still remains within the disc

Question 13

What symptoms are associated with disc extrusion?

Answer 13

Pain (the nuclear material stimulates an inflammatory response)

Question 14

What is disc sequestration?

Answer 14

The nucleus pulposus breaks through the annulus fibrosis and fragments become free in the spinal canal

Question 15

What symptoms are associated with disc sequestration?

Answer 15

The free fragment can cause unpredictable and severe nerve compression, as well as possible permanent neurological damage

Question 16

What causes lateral canal stenosis?

Answer 16

Bony spurs forming as a result of cervical spondylosis (degenerative changes)

Question 17

True or false: Degenerative changes are always associated with symptomology

Answer 17

False

Question 18

Which age group typically experiences lateral canal stenosis?

Answer 18

Patients over 40 years of age

Question 19

True or false: Patients with lateral canal stenosis often have a history significant acute trauma

Answer 19

False (correction: often no history of acute trauma)

Question 20

The C5 nerve root exits from which disc level?

Answer 20

C4/C5 disc

Question 21

What is the pain pattern characteristic of C5 radiculopathy?

Answer 21

Neck, shoulder, medial border of the scapula, and upper arm

Question 22

What is the sensory disturbance of C5 radiculopathy?

Answer 22

Deltoid area and the radial aspect of the upper arm

Question 23

What is the reflex disturbance of C5 radiculopathy?

Answer 23

Biceps

Question 24

What is the pattern of motor loss that is characteristic of C5 radiculopathy?

Answer 24

Deltoid, biceps, supraspinatus, and infraspinatus

Question 25

The C6 nerve root exits from which disc level?

Answer 25

C5/C6 disc

Question 26

What is the pain pattern characteristic of C6 radiculopathy?

Answer 26

Neck, shoulder, medial border of the scapula, radial aspect of the upper arm and forearm, thumb, and index finger

Question 27

What is the sensory disturbance of C6 radiculopathy?

Answer 27

Thumb and index fingers, radial aspect of the hand and forearm

Question 28

What is the reflex disturbance of C6 radiculopathy?

Answer 28

Biceps and brachioradialis

Question 29

What is the pattern of motor loss that is characteristic of C6 radiculopathy?

Answer 29

Biceps, brachioradialis, and wrist extensors

Question 30

The C7 nerve root exits from which disc level?

Answer 30

C6/C7 disc

Question 31

What is the pain pattern characteristic of C7 radiculopathy?

Answer 31

Neck, dorsal and palmar surfaces of the forearm, medial border of the scapula

Question 32

What is the sensory disturbance of C7 radiculopathy?

Answer 32

Middle finger

Question 33

What is the reflex disturbance of C7 radiculopathy?

Answer 33

Triceps

Question 34

What is the pattern of motor loss that is characteristic of C7?

Answer 34

Triceps, wrist flexors, and finger extensors

Question 35

The C8 nerve root exits at which disc level?

Answer 35

C7/T1 disc

Question 36

What is the pain pattern characteristic of C8 radiculopathy?

Answer 36

Neck, scapula, ulnar aspect of the upper arm and forearm, ring fingers, and pinky fingers

Question 37

What is the sensory disturbance of C8 radiculopathy?

Answer 37

Ring finger, pinky finger, and medial forearm

Question 38

What is the reflex disturbance of C8 radiculopathy?

Answer 38

There is no reflex

Question 39

What is the pattern of motor loss that is characteristic to C8 radiculopathy?

Answer 39

Finger flexors and abductor pollicus brevis

Question 40

What are the 3 keys signs that indicate cervical radiculopathy should be included as a differential diagnosis?

Answer 40

1. Spurling sign 2. Relief with manual cervical distraction 3. Bakody's sign

Question 41

What is Spurling sign?

Answer 41

Pain that radiates down the arm during extension, lateral flexion, and axial loading on the affected side

Question 42

What is Bakody's sign?

Answer 42

Relief of arm pain by placing and resting the patient's forearm on the top of the head

Question 43

What is reverse Bakody and what does it suggest?

Answer 43

Increased arm pain when resting the forearm on the top of the head, which suggest TOS

Question 44

Are the 3 clinical signs (spurling sign, relief with distraction, bakody's sign) sensitive or specific?

Answer 44

Highly specific, but only about 50% sensitive

Question 45

True or false: A patient with all 3 clinical signs (spurling sign, relief with distraction, bakody's sign) is very likely to have radiculopathy, but a person with radiculopathy may not have any of these signs

Answer 45

True

Question 46

What is pseudoradiculopathy?

Answer 46

Neck pain radiating into the arms that is not necessarily due to cervical nerve root irritation

Question 47

Pain associated with pseudoradiculopathy is commonly caused by ___ referral

Answer 47

Sclerotome-like (pain patterns do not follow a typical dermatomal distribution)

Question 48

What causes pain to refer in a sclerotome-like pattern?

Answer 48

Myofascial trigger points in paraspinal musculature and shoulder girdle muscles

Question 49

What are the typical referral patterns of scalene trigger points?

Answer 49

Pain may refer into the shoulder and arm, as well as the hand, medial border of the scapula, and chest

Question 50

What is referred to as the "anatomical bermuda triangle"?

Answer 50

The scalene muscle group

Question 51

Which muscles have trigger point referral patterns that resemble cervical radiculopathy?

Answer 51

Scalenes, infraspinatus, and supraspinatus

Question 52

What are the common causes of pseudoradiculopathy?