Anesth Pain Med.  2019 Apr;14(2):216-221. 10.17085/apm.2019.14.2.216.

Painless cervical motor radiculopathy relieved by cervical epidural steroid injection: A case report

• Lee I
• Hong S
• You H
• Hong SJ
• Kang SS

• KMID: 2447973
• DOI: http://doi.org/10.17085/apm.2019.14.2.216

Abstract

A 15-year-old male patient presented with a slow progression of painless right shoulder weakness over the previous six weeks. The magnetic resonance imaging revealed right C4-5 foraminal stenosis caused by right foraminal disc protrusion. The needle electromyography and nerve conduction studies revealed acute C5 and/or C6 radiculopathy. Instead of the initial surgical management modalities, we performed a cervical epidural steroid injection at the C4-5 level. From the day after the patient received the cervical epidural steroid injection, his right shoulder motor weakness improved progressively. Two weeks after the procedure, his right shoulder motor function had fully recovered.

Keyword

Cervical; Epidural; Motor; Radiculopathy

MeSH Terms

Adolescent
Constriction, Pathologic
Electromyography
Humans
Magnetic Resonance Imaging
Male
Needles
Neural Conduction
Radiculopathy*
Shoulder

Figure

• 

  Fig. 1 C4–5 cervical spine magnetic resonance imaging. The T2-weighted axial (A) and T1-weighted axial views (B) show foraminal stenosis caused by disc protrusion (white arrow) in the right C4–5. The T2-weighted sagittal (C) and T1-weighted sagittal (D) views show mild disc protrusion in the right C4–5 (black arrow). In comparison with other foramens, there is more severe foraminal stenosis in the right C4–5 (arrowhead) on the T2-weighted right oblique view (E).

• 

  Fig. 2 Needle electromyography and nerve conduction studies. In the needle elecdtromyography (A), there are denervation potential in the resting state and a reduced recruitment pattern at maximal contraction in the right pronator teres, biceps brachii, deltoid, infraspinatus, supraspinatus, and paraspinal muscles. In the nerve conduction studies, the motor (B) and sensory (C) nerve conduction are normal. Ins Act: insertional activity, Fibs: fibrillations, Psw: positive sharp waves, Amp: amplitude, Int Pat: interference pattern, Norm: normal, Dist: distance, Vel: velocity, ABD: abductor, BPI: brachial plexus injury, MCN: musculocutaneous, Med: median, UI: ulnar, Lt.: left, Rt.: right, MABC: medial antebrachial cutaneous, LABC: lateral antebrachial cutaneous, Sup: supraspinatus, rad: radial.

• 

  Fig. 3 Epidural steroid injection in right C4–5. The epidural space was confirmed with contrast media in the antero-posterior (A), sagittal (B), right oblique (C), and left oblique (D) views.

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