Presentation
Severe right scapular and proximal forearm pain for 4 weeks.
Patient Data
Cervical spine is normally aligned. Diffuse cervical spondylosis, more severe at C6-7. No high-grade spinal canal stenosis. High-grade right C5-6 neural exit foraminal stenosis. No fracture. No bone lesion. No facet arthropathy.
Normal alignment. Visualized spinal cord is of normal signal intensity and caliber. Unremarkable craniocervical fossa and visualized posterior cranial fossa. T3 hemangioma.
C2-3: No intervertebral disc herniation. Spinal canal and neural exit foramina are capacious.
C3-4: Posterior osteophytes and facet joint arthropathy. Mild spinal canal stenosis and mild left neural exit foraminal stenosis. Right neural exit foramen is capacious.
C4-5: Right facet joint arthropathy contributes to mild right neural exit foraminal stenosis. Spinal canal and left neural exit foramen are capacious.
C5-6: Disc, uncovertebral arthrosis and facet joint arthropathy result in mild spinal canal stenosis, and mild left and severe right neural exit foraminal stenosis with deformation of the exiting right C6 nerve root.
C6-7: Disc and uncovertebral arthrosis contribute to mild spinal canal and mild bilateral neural exit foraminal stenosis.
C7-T1: Uncovertebral arthrosis result in mild bilateral neural exit foraminal stenosis. Spinal canal is capacious.
Cervical nerve root injection
Under CT guidance, a needle was advanced to the right C5-6 neural exit foramen. Subsequently, non-particulate steroid and short-acting local anesthetic was injected.
The patient's usual symptoms were provoked with pain in the right scapular region during the injection.
Post procedure Stephen reported the right scapular region and proximal forearm symptoms were improved.
Case Discussion
Typical presentation of right C6 radiculopathy with corresponding severe right C5-6 neural exit foraminal stenosis and flattening of the right C6 nerve root. The patient had a good initial response to a right C6 nerve root block.