Pain and weakness in hand: Differential diagnosis between cervical radiculopathy and brachial plexopathy

Abstract

The lecture is dedicated to the topical problem of neurology — differential diagnosis between cervical radiculopathy and brachial plexopathy. The basic principles and steps of clinical diagnostics, possibilities, and stages of electrophysiological diagnosis of the functionality of the cervical root and trunk of the shoulder plexus are considered.The purpose of the first stage of diagnostics is to determine the origin of the pain syndrome: whether it has a neurogenic nature, or is the aftereffect of the damage to the locomotor system. In the case of neurogenic pathology, the task of the second stage is a clear verification of C5, C6, C7, C8, T1 radiculopathy by evaluating the maximum measurements of motor and sensory nerves originating from a particular root. Accordingly, the differential diagnosis of brachial plexopathy, thoracic outlet syndrome, and mononeuropathy of the nerves of the arm is also based on strict observation of the peculiarities of their location.There were analyzed the opportunities of various methods of electrophysiological diagnostics, namely, stimulation and needle electromyography in solving the problems of topical diagnosis are outlined, as well the evidence of using the method of electromyographic paraspinal mapping at the cervical level for the differential diagnosis between plexopathy and radiculopathy. However, it is maintained that the attending physician should establish the nosological diagnosis. The article presents the clinical cases and restrictions of electromyographic diagnostics in the differentiation of controversial issues. The material of the lecture is based on the review of a significant number of neurosurgical, neurological and orthopedic sources; the author also included the results of her own research performed over the past 20 years including those carried out during the neurosurgery follow-up of about 300 patients.