Oblique projectional radiograph of a man presenting with pain by the nape and left shoulder, showing a stenosis of the left intervertebral foramen of cervical spinal nerve 4, corresponding with the affected dermatome. CT scan of a man presenting with<unk>  of the left cervical spinal nerve 7, corresponding to spondylosis with osteophytes between the vertebral bodies C6 and C7 on the left side, causing foraminal stenosis at this level (lower arrow, showing axial plane). There is also spondylosis of the facet joint between C2 and C3, with some foraminal stenosis at this level (upper arrow), which appears to be asymptomatic. Signs and Symptoms<unk>  is a diagnosis commonly made by physicians in primary care specialties, orthopedics, physiatry, and neurology. The diagnosis may be suggested by symptoms of pain, numbness, paresthesia, and weakness in a pattern consistent with the distribution of a particular nerve root, such as sciatica. Neck pain or back pain may also be present. Physical examination may reveal motor and sensory deficits in the distribution of a nerve root. In the case of cervical<unk> , Spurling's test may elicit or reproduce symptoms radiating down the arm. Similarly, in the case of lumbosacral<unk> , a straight leg raise maneuver or a femoral nerve stretch test may demonstrate<unk> c symptoms down the leg. Deep tendon reflexes (also known as a Stretch reflex) may be diminished or absent in areas innervated by a particular nerve root. Diagnosis typically involves electromyography and lumbar puncture. Shingles is more common among the elderly and immunocompromised; usually (but not always) pain is followed by appearance of a rash with small blisters along a single dermatome. It can be confirmed by quick laboratory tests. Acute Lyme<unk>  follows a history of outdoor activities during warmer months in likely tick habitats in the previous 1–12 weeks. In the U.S., Lyme is most common in New England and Mid-Atlantic states and parts of Wisconsin and Minnesota, but it is expanding to other areas. The first manifestation is usually an expanding rash possibly accompanied by flu-like symptoms. Lyme<unk>  is usually worse at night and accompanied by extreme sleep disturbance, lymphocytic meningitis with variable headache and no fever, and sometimes by facial palsy or Lyme carditis. Lyme can also cause a milder, chronic<unk>  an average of 8 months after the acute illness. Lyme can be confirmed by blood antibody tests and possibly lumbar puncture. If present, the above conditions should be treated immediately. Although most cases of<unk>  are compressive and resolve with conservative treatment within 4–6 weeks, guidelines for managing<unk>  recommend first excluding possible causes that, although rare, require immediate attention, among them the following. Cauda equina syndrome should be investigated in case of saddle anesthesia, loss of bladder or bowel control, or leg weakness. Cancer should be suspected if there is previous history of cancer, unexplained weight loss, or low-back pain that does not decrease by lying down or is unremitting. Spinal epidural abscess is more common among those with diabetes mellitus or immunocompromised, who use intravenous drugs, or had spinal surgery, injection or catheter; it typically causes fever, leukocytosis and increased erythrocyte sedimentation rate. If any of the previous is suspected, urgent magnetic resonance imaging is recommended for confirmation. Proximal diabetic neuropathy typically affects middle aged and older people with well-controlled type-2 diabetes mellitus; onset is sudden causing pain usually in multiple dermatomes quickly followed by weakness. Investigations If symptoms do not improve after 4–6 weeks of conservative treatment, or the person is more than 50 years old, further tests are recommended. The American College of Radiology recommends that projectional radiography is the most appropriate initial study in all patients with chronic neck pain. Two additional diagnostic tests that may be of use are magnetic resonance imaging and electrodiagnostic testing. Magnetic resonance imaging (MRI) of the portion of the spine where<unk>  is suspected may reveal evidence of degenerative change, arthritic disease, or another explanatory lesion responsible for the patient's symptoms. Electrodiagnostic testing, consisting of NCS (nerve conduction study) and EMG (electromyography), is also a powerful diagnostic tool that may show nerve root injury in suspected areas. On nerve conduction studies, the pattern of diminished Compound muscle action potential and normal sensory nerve action potential may be seen given that the lesion is proximal to the posterior root ganglion. Needle EMG is the more sensitive portion of the test, and may reveal active denervation in the distribution of the involved nerve root, and neurogenic-appearing voluntary motor units in more chronic<unk> es. Given the key role of electrodiagnostic testing in the diagnosis of acute and chronic<unk> es, the American Association of Neuromuscular & Electrodiagnostic Medicine has issued evidence-based practice guidelines, for the diagnosis of both cervical and lumbosacral<unk> es. The American Association of Neuromuscular & Electrodiagnostic Medicine has also participated in the Choosing Wisely Campaign and several of their recommendations relate to what tests are unnecessary for neck and back pain.
Radiculopathy
Tennis elbow
Myopathy
Adhesive capsulitis of the shoulder
Diabetic neuropathy
Autonomic neuropathy
Tropical neuropathy
Neurocristopathy