Radiculopathy of the Eighth Cervical Nerve

STUDY DESIGN: Resident's case problem. BACKGROUND: The C8 nerve root is the least commonly encountered of cervical radiculopathies. The purpose of this resident's case problem is to provide an unusual presentation of a C8 radiculopathy, without cervical or proximal upper quarter symptoms, diagnosed by a combination of physical examination, electromyography (EMG) and nerve conduction studies (NCSs), and imaging. DIAGNOSIS: A 49-year-old, right-hand-dominant male was referred to the EMG/NCS laboratory for a suspected left ulnar neuropathy at the elbow. A physical examination, NCS, and EMG were performed, and a C8 radiculopathy involving both the anterior and posterior primary rami was identified. Following the EMG and NCS evaluation, the patient had enhanced magnetic resonance imaging studies that confirmed a foraminal C7-T1 herniation and associated small central disc protrusion. The patient was then referred to neurosurgery for further consultation and subsequent surgical intervention. The patient underwent a C7-T1 laminectomy, mesial facetectomy, and foraminotomy, and excision of a herniated disk using an operating microscope. The neurosurgeon noted that there was a large disk herniation containing some disk material immediately anterior to the C8 motor root, that impinged directly on the motor root. One month postoperatively, the patient had decreased pain and numbness and tingling in his arm and his hand weakness had improved. DISCUSSION: The report illustrates the utility of a combination of physical examination, EMG and NCSs, and imaging in the diagnosis of a C8 radiculopathy in a patient presenting with forearm and hand symptoms but without cervical or upper quarter symptoms. LEVEL OF EVIDENCE: Diagnosis, level 4. J Orthop Sports Phys Ther 2010;40(12):811-817 doi:10.2519/jospt.2010.3187