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T2 radiculopathy: A differential screen for upper extremity radicular pain
1Institute of Therapeutic Sciences, Livonia, MI, USA. institutemanualpt@yahoo.com
Physiotherapy Theory and Practice
|July 13, 2012
Summary
Upper extremity radicular pain may originate from the upper thoracic spine, not just the cervical spine. Mechanical dysfunction in the upper thoracic region can cause radiating arm pain, responding well to manual therapy and exercise.
Area of Science:
- Neurology
- Orthopedics
- Pain Management
Background:
- Cervical radiculopathy is a common cause of upper extremity radicular pain.
- Cutaneous representations of the T2 nerve root suggest potential referred pain patterns to the axilla and upper limb.
Observation:
- A patient presented with severe right upper thoracic pain radiating to the axilla, upper arm, and lateral forearm.
- Cervical spine examination was unremarkable, but mechanical dysfunction at the cervicothoracic junction (C8-T2) was identified.
- Palpation of the upper thoracic vertebrae reproduced the patient's symptoms.
Findings:
- Manual therapy and corrective exercises targeting the cervicothoracic junction and upper thoracic region resolved the patient's radicular pain.
- The patient's pain decreased from 10/10 to 2/10 on the numerical pain rating scale.
- Improved cervical extension and reduced local tenderness were noted post-treatment.
Implications:
- Mechanical dysfunction of the upper thoracic vertebrae is a potential, often overlooked, source of upper extremity radicular pain.
- The second thoracic intercostal nerve and its cutaneous branches may mediate these symptoms.
- This case highlights the importance of examining the entire cervicothoracic region for radicular pain etiology.
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