Cervical Spondylosis – Clinical Presentation
– the pain pattern is difficult to use as a way of sorting out what is going on in their spine; go with neurology!
– weakness, clumsiness, L’Hermitte’s
– the weakness is often greater distal than proximal
– look for ataxic, broad based gait
– motor weakness is seen in 61-68%
– reflexes are decreased in 70%
– it is sometimes difficult to sort out the exact level of neural compression
– Spurling’s Sign: rotate and extend towards the side of complaints – exacerbates the symptoms
– Axial Compression: further diminishes foraminal volume (can be done with Spurling maneuver)
– Valsalva Maneuver: may increase symptoms
– L’Hermitte’s phenomenon – electric shock down trunk and upper extremities with neck flexion
– overlapping findings are common, with many presenting without dermatomal pain pattern.
– look for upper motor neuron signs – hyperreflexia, spasticity, pathologic reflexes
– ankle clonus, Babinski’s
– Hoffman’s Reflex – flick the nail of the third finger and look for flexion of index and thumb
– Inverted Radial Reflex – testing brachioradialis reflex elicits flexion of fingers – seen with compression of both C5 cord and roots.
Level Root Motor Sensory Loss
C3-4 C4 Scapula Lateral neck, shoulder
C4-5 C5 Deltoid, Biceps Lateral arm
C5-6 C6 Wrist ext, biceps, supination Radial forearm & hand
C6-7 C7 Triceps, pronation Middle finger C7-8 C8 Finger flexion, interossei Ulnar forearm and hand
C8-T1 T1 Interossei Ulnar arm