Atypical presentation of C-7 radiculopathy

The authors retrospectively reviewed the presenting symptomatology and 6-month outcome in 241 consecutive patients who underwent C6-7 anterior cervical discectomy (ACD) from an overall series of 1008 patients in whom the senior author performed one-level procedures.

In 28 (12%) of the 241 patients, the sole complaint was subscapular pain on the side ipsilateral to nerve root compression. In 11 patients (5%), the primary complaint was unilateral deep breast or chest pain. No patient experienced any of the traditional radicular signs involving C-7 such as numbness of the second or third digits, pain in the triceps, and/or atrophy or weakness of the triceps or pronator muscles. Of the 28 patients presenting with subscapular pain 238 (93%) of 241 experienced complete symptom relief within 6 months, and of the 11 who presented with chest pain complete relief or relief to the point of requiring nonnarcotic analgesic agents occurred in nine cases.

Approximately 15% of patients with a C-7 radiculopathy are likely to present with atypical symptoms that, if persisting after nonsurgical therapy, will often resolve after ACD and fusion.