Patients presenting with arm pain may present with mixed clinical signs that can make it difficult to distinguish whether the pain is local in its origin or indeed arising from the cervical spine.
In these clinical scenarios, an MRI of the cervical spine reliably demonstrates any intervertebral disc pathology compressing nerves, as well as any lesion within or surrounding the spinal cord that has potential to account for the patient’s symptoms. The most frequent diagnosis encountered on MRI is that of a disc herniation resulting in direct compression of a spinal nerve. When this corresponds with the clinical findings, for example matching the dermatomal distribution with the patient’s symptoms, then the diagnostic specificity and sensitivity of MRI is high.
MRI is the main modality utilised in the assessment of cervical radiculopathy, particularly fluid sensitive sequences, known as T2 weighted imaging, which have the ability to visualise bone, disc, ligaments, cerebrospinal fluid, spinal nerves and the cord.
MRI serves as a roadmap for performing any proposed intervention, including radiological guided injections (typically a CT guided foraminal injection of corticosteroid) that may assist in the relief of patient’s symptoms, should the patient not respond to conservative measures. An injection can be particularly useful in the acute setting where the patient is experiencing severe and unrelenting pain.