Unexpected neuroimaging abnormalities in patients with apparent C8 radiculopathy: Broadening the clinical spectrum

Introduction: C8-root impingement by C7/T1 lesions on neuroimaging studies is not consistently observed in C8 radiculopathy. We hypothesized that C7 or T1 root lesions (with a pre- or postfixed plexus) or cervical myelopathy might explain some C8 radiculopathies without C8 root compression. Methods: Retrospective analysis of cervical neuroimaging in 31 consecutive patients with EMG-confirmed C8 radiculopathy. Results: Five patients (16%) had C8-root compression at C7/T1. Of those without C8-root compression, 5 (16%) had C7-root compression at C6/7, one (3%) had T1-root compression at T1/T2, 7 (23%) had cervical cord compression at or above the C6/7 level, 4 (13%) had intramedullary cervical lesions, and 9 (29%) had mild or nonspecific findings. Conclusions: C8 radiculopathy without C8-root compression may be due to C7-root compression in the setting of a prefixed brachial plexus, upper cervical cord compression with vascular compromise of the distal cervical spinal cord (myelopathic hand), or intramedullary cervical cord lesions. Muscle Nerve 45: 859865, 2012