Radiculopathy is defined as pain and peripheral neurological deficits within a specific nerve root distribution [16]. In radiculopathy, peripheral symptoms of arm pain, numbness/tingling, and/or weakness generally exceed symptoms of neck pain [16]. Radicular symptoms are expected to be reproducible, and may be acute or chronic. They can present as isolated pain, numbness, or weakness or a combination of these symptoms [16]. Depending on the etiology of cervical radiculopathy , patients may present with a single nerve root affected, multiple levels affected, or bilateral symptoms [16]. Radicular symptoms are typically affected by neck position. Commonly, athletes will report exacerbation of symptoms with lateral rotation of the neck, lateral flexion/bend, and neck extension [16].

Vascular connective tissue surrounds cervical nerve roots and protects the nerve roots from injury [5]. Cervical radiculopathy results from compression or injury to the cervical nerve roots as they exit the cervical foramen. Compression can be caused by multiple etiologies including disc herniation, cervical foraminal stenosis from degenerative arthritis, or from other less common etiologies such as infection, tumor, or fracture [17]. In contrast to these compressive etiologies, there are occasions in sports where radiculopathy may occur from excessive traction forces applied along the length of the nerve root [5]. Some of these peripheral nerve traction injuries are described as “stinger” or “burners” and are described in more detail in other parts of this book.

On physical exam, a positive Spurling’s test is described as reproduction of symptoms with axial loading of the cervical spine with the neck in hyperextension and ipsilateral rotation [16]. Spurling’s maneuver consists of two steps: it begins with axial loading with the neck in extension. If radicular symptoms are not reproduced with neck extension, the second part of the test is performed and consists of rotation of the extended neck toward the symptomatic arm. The test is positive if radicular symptoms are elicited [17]. Spurling’s maneuver is positive in 25–50 % of patients with discogenic radiculopathy [16]. The head compression test can also be helpful in diagnosing radiculopathy. Symptoms may improve with axial traction (10–15 lb) or elevation of the hands above the head [15, 16, 18]. The shoulder abduction test involves abducting the arm and putting the patient’s hand behind their head . This test is considered positive confirmation of cervical radiculopathy if this maneuver relieves the patient’s radicular pain or numbness (Bakody’s sign) [17, 18].

Clinical evaluation of radiculopathy includes evaluation of cervical nerve roots to identify which levels are affected. A brief review of cervical nerve root distributions is given in Table 12.1 [15–18].

The work-up of radiculopathy includes plain radiographs and an MRI. Electromyography (EMG) may be helpful when multiple disc levels or dermatomes are affected. It may also be helpful when a coexisting peripheral nerve impingent is involved such as a carpal tunnel syndrome with a C-6 radiculopathy. This situation, where nerve symptoms are potentiated by a more proximal nerve compromise is often called a double crush syndrome .

After confirming the diagnosis with an MRI, athletes with herniated discs frequently respond to conservative, nonoperative treatment including relative rest, NSAIDs, and physical therapy. For severe or refractory symptoms sometimes oral or injectable corticosteroids are considered [10]. If conservative measures fail or if neurologic symptoms progress, surgical decompression may be needed. In the setting of radiculopathy, three clinical situations warrant surgical consideration: progressive motor weakness, loss of bowel or bladder control (extremely rage, but emergent), and refractory symptoms. The latter situation is somewhat subjective. In severe pain, this may be as early as 6–8 weeks. In moderate cases, it may be months before surgery is considered [2]. In most instances of cervical disc herniation, surgery to include an anterior cervical discectomy and fusion is the standard of care [10]. Surgical management of far lateral cervical disc herniations that do not respond to conservative treatment usually includes minimally invasive posterior foraminotomy and nerve root decompression [10].