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Cervical Root Exam

Exams and Signs

Historical Overview

Manual muscle testing, an important part of the cervical root exam, was developed by Lovett in 1912.1

Description

The possibility of underlying cervical spine pathology as a source of upper limb symptoms can be explored by a simple clinical exam including sensory, motor and reflex tests.2

Pathophysiology

  • Cervical radiculopathy, improper nerve function due to nerve root compression, can result from a variety of cervical spine pathologies:2,3
    • Disc herniation
    • Spondylosis of the facet joints
    • Instability
    • Trauma
    • Tumor

Instructions

RootDisc(s)Sensory areaExample of motor function
and muscle group		Reflex
C5C4–C5Lateral arm, superficial to  deltoidShoulder abduction, deltoidBiceps tendon at elbow
C6C5–C6Thumb and radial aspect of wristElbow flexion in supination, brachioradialisBrachioradialis at radial insertion
C7†C5–C6Middle fingerElbow extension, tricepsTriceps tendon at elbow
C8

C7–C8

C8–T1

Small finger and ulnar side of ring finger

Finger flexion,

flexor digitorum superficialis

N/A
T1T1–T2Medial side of forearmFinger abduction, interosseiN/A

†Most commonly involved2,3

1. Take patient history, note pain and/or paresthesia, which are the most common symptoms.3

2. Perform sensory tests (see table for relevant dermatome):

  • Soft touch (do not stroke)
  • Sharp touch (pain)
  • 2-point discrimination
  • Vibration (128-Hz tuning fork)
  • Temperature
  • Proprioception

3. Motor tests

  • Strength
    • Shoulder abduction
    • Elbow flexion in supination
    • Elbow extension
    • Finger flexion
    • Finger abduction
    • Reflex
      • Biceps tendon at elbow
      • Brachioradialis at radial insertion
      • Triceps tendon at elbow

Related Signs and Tests

  • Spurling’s test1,5
  • Neck distraction test1
Presentation Photos and Related Diagrams
  • Motor, sensory and biceps reflex exam for C5 Root
    Motor, sensory and biceps reflex exam for C5 Root
  • Motor, sensory and triceps reflex exam for C6 Root
    Motor, sensory and triceps reflex exam for C6 Root
  • Motor, sensory and triceps reflex exam for C7 Root
    Motor, sensory and triceps reflex exam for C7 Root
  • Motor and sensory exam for C8 Root
    Motor and sensory exam for C8 Root
Definition of Positive Result
  • A positive (abnormal) result occurs when there is motor weakness, lack of normal sensation or an abnormal reflex.
Definition of Negative Result
  • A negative result occurs when there is normal muscle strength, normal sensation, and normal reflexes.
Comments and Pearls
  • Cervical myelopathy, compression of the spinal cord, should be considered as part of the differential diagnosis.2
  • Imaging studies (x-ray, computed tomography, magnetic resonance imaging) and electrophysiological testing can assist in identifying the cause of any detected neuropathy.3
Diagnoses Associated with Exams and Signs
References
  1. Paternostro-Sluga T, Grim-Stieger M, Posch M, et al. Reliability and validity of the medical research council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008;40(8):665-671. PMID: 19020701
  2. Micev AJ, Ivy AD, Aggarwal SK, et al. Cervical radiculopathy and myelopathy: Presentations in the hand. J Hand Surg Am 2013;38(12):2478-81. PMID: 24054072
  3. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J 2011;7(3):265-272  PMID: 23024624
  4. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994;117(Pt 2):325-335.  PMID: 8186959
  5. Shabat S, Leitner Y, David R, Folman Y. The correlation between Spurling test and imaging studies in detecting cervical radiculopathy. J Neuroimaging 2012;22(4):375-378. PMID: 21883627
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