Mimickers of Cervical Radiculopathy

Degenerative changes of the cervical spine are the primary cause of nerve root compression leading to symptomatic radiculopathy. Genetic and age-related changes, including loss of intervertebral disc height, as well as facet and uncovertebral joint hypertrophy, produce narrowing of the neural foramen. A herniated nucleus pulposus may cause acute foraminal stenosis. Symptomatic nerve root compression may ensue, leading to pain radiating from the neck into the shoulder, arm, forearm, and/or hand, with or without accompanying numbness and paresthesias. Several musculoskeletal and nonmusculoskeletal entities have a presentation similar to that of cervical radiculopathy and can be easily overlooked if the diagnosis of radiculopathy is assumed (Table I). Therefore, the clinician should be familiar with the classic signs and symptoms of cervical radiculopathy as well as a spectrum of differential diagnoses that may mimic it. View this table: TABLE I Mimickers of Cervical Radiculopathy by Nerve Root Patients with cervical radiculopathy may report antecedent trauma, but the typical onset is more insidious. Acute, severe pain in a dermatomal distribution typically results from cervical disc herniation, whereas subacute, chronic, or intermittent radicular pain tends to be secondary to a chronically herniated disc or degenerative foraminal stenosis. Henderson et al.1, in a report on >700 patients who had been diagnosed with cervical radiculopathy, noted upper extremity pain in 99.4% of the patients, sensory changes to pinprick in 85.2%, neck pain in 79.7%, diminished reflexes in 71.2%, and diminished strength in 68%. Nearly 54% of the patients experienced pain or paresthesias in a dermatomal pattern, …