Radiating Pain

Question 1

Cervical Radiculopathy symptoms

Answer 1

Characteristics/Clinical Presentation

Typical Dermatomal Pattern of the Upper Limb
Typical symptoms of cervical radiculopathy are: irradiating arm pain corresponding to a dermatomal pattern, neck pain, parasthesia, muscle weakness in a myotomal pattern, reflex impairment/loss, headaches, scapular pain, sensory and motor dysfunction in upper extremities and neck[2][6][3][13][14].

Upper limb movements that are affected:

C1/C2- Neck flexion/extension
C3- Neck lateral flexion
C4- Shoulder elevation
C5- Shoulder abduction
C6- Elbow flexion/wrist extension
C7- Elbow extension/wrist flexion
C8- Thumb extension
T1- Finger abduction

Question 2

TOS signs and symptoms?

Answer 2

Signs and symptoms of thoracic outlet syndrome vary from patient to patient due to the location of nerve and/or vessel involvement. Symptoms range from mild pain and sensory changes to limb threatening complications in severe cases.

Patients with thoracic outlet syndrome will most likely present pain anywhere between the neck, face and occipital region or into the chest, shoulder and upper extremity and paresthesia in upper extremity. The patient may also complain of altered or absent sensation, weakness, fatigue, a feeling of heaviness in the arm and hand. The skin can also be blotchy or discolored. A different temperature can also be observed.

Signs and symptoms are typically worse when the arm is abducted overhead and externally rotated with the head rotated to the same or the opposite side. As a result activities such as overhead throwing, serving a tennis ball, painting a ceiling, driving, or typing may exacerbate symptoms.[13][14]

When the upper plexus (C5,6,7) is involved there is pain in the side of the neck and this pain may radiate to the ear and face. Often the pain radiates from the ear posteriorly to the rhomboids and anteriorly over the clavicle and pectoralis regions. The pain may move laterally down the radial nerve area. Headaches are not uncommon when the upper plexus is involved.

Patients with lower plexus (C8,T1) involvement typically have symptoms which are present in the anterior and posterior shoulder region and radiate down the ulnar side of the forearm into the hand, the ring and small fingers.[3][5]