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