Case 14 Cervical Radiculopathy and Myelopathy


Case 14
Cervical Radiculopathy and Myelopathy
What happened ?                                             What are difficulties ?

Clinical Examination

Introduction ownself
Exposure – Upto Umbilicus 
Hand scrubbing
Look- Standing Patient

Comment on Cervical Collar
Attitude of the limb
Alignment       -           Front    Head at Centre
 Both shoulders are leveled,
                                                Chest is symmetric on both the sides
                                    No wasting of muscles on chest , shoulder ,arm , forearm                                                     , thenar and hypothenar muscles with normal overlying skin

                                    Side       Normal cervical lordosis
                                                  Maintained deltoid contour , elbows extended ,
                                    Back               
  Spinal curvature is maintained with no kyphoscoliosis
  Normal overlying skin on back with no dimpling , tuft of hair
      and swelling
 No wasting of muscles on supr and intraspinatus fossa ,shoulder               and dorsal surface of arm , forearm and hands

Gait                                         Normal / Stooped wide based gait /frequent fall or early shuffling
Ask Patient to Sit
Neck ROM –                          Decreased ROM particularly Lateral Flexion
Lumbar ROM
Spurling sign + -                      Hyperextension + Lateral rotation towards affected side + gentle           compression – if illicits Pain – s/o Radiculopathy
Shoulder Abduction sign        + , Relief of pain with hands putting on head with shoulder abducted.
Hoffman’s Reflex                   Reflex – thumb and other fingers extend with sudden long finger DIP joint extension
Scapulohumeral Reflex           Taping spine of scapula illicits a brisk scapular elevation and abduction of humerus .
Reverse Asymmetric Jerk       Biceps / Supinator
Inverted Radial Reflex           During testing Brachioradialis reflex , the response is reciprocal spastic contracture of fingers.
Lhermitte’s Sign                     Neck – Flexion leads to burning sensation involving upper and lower extremities and trunk.
Finger Escape Sign                 In making a grip , 2 ulnar digits drift out.
                                                In grip and release test , patient unable to form a fist and release all digits within 10 seconds period
Neurovascular Examination
UE – C 5 – T 1
LE – l2 – S 5
Spasticity / Clonus
Sensation – including joint position which is maintained
Power

Reflexes – Knee and Ankle – Brisk bilaterally
                  Plantar reflex upgoing

In case of Myelopathy spasticity , clonus , brisk reflexes , plantar upgoing.
Cervical Radiculopathy has LMN type presentation .


Discussion

Investigations
X-ray - C- spine –AP / Lateral
MRI
Blood – CBC ,ESR, CRP


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