1. Spinal cord-type cervical spondylosis.
The typical clinical manifestations of spinal cord-type cervical spondylosis are mainly lower motor neuron damage in the upper extremities and upper motor neuron damage in the lower extremities. The former mainly reflects the severity of damage to the spinal cord in the compressed segment, while the latter is due to simultaneous involvement of the lateral tracts of the corticospinal cord and the lateral tracts of the spinal cord thalamus. When the lesion involves only the central gray matter of the spinal cord, especially the anterior and/or posterior horn of the spinal cord, the clinical manifestations are mainly lower motor neuron paresis of the upper extremities bilaterally, with diminished or absent tendon reflexes, but no abnormal findings on examination of the lower extremities. This particular type of spinal cord cervical spondylosis has rarely been mentioned in the literature in the past, while in fact this particular type of cervical spinal cord damage is not uncommon. When spinal cord cervical spondylosis presents with symptoms in one upper extremity, the information provided by MRI is often of great value. Neurogenic cervical spondylosis can also coexist with spinal cord cervical spondylosis.
2. Occipital and atlantoaxial spine disorders.
Occipital cervical injuries and diseases often cause occipital neuralgia. The occipital nerve is a sensory nerve composed of the posterior branch of the cervical 2 nerve, and it is difficult to distinguish from pain caused by damage to the cervical 3 nerve root.
3, other disorders of the cervical spine.
Such as spinal stenosis, ossification of the posterior longitudinal ligament, infection, tumor, etc., imaging examination can clarify the diagnosis.
4.Lung and mediastinal tumors.
Such as tumor of the superior pulmonary sulcus, which can invade the brachial plexus and cause shoulder and arm pain, a mass can be palpated in the supraclavicular fossa on physical examination, and imaging examination can clarify the location and scope of the tumor.
5. Thoracic outlet syndrome.
The main etiology includes cervical assistance, hypertrophy of anterior oblique muscle and malformation healing or non-healing of clavicle, rostral process of scapula or 1st rib. The most common symptoms are pain, numbness or fatigue in the upper extremity, followed by pain in the shoulder and scapula, and again in the neck. Depending on the components of compression, the symptoms can be mainly nerve, arterial or venous compression, most of which are mainly nerve compression symptoms, with the lower trunk of the brachial plexus being involved more often, so the symptoms are often manifested as damage to the ulnar nerve innervation area. Commonly used physical examination methods include Morley test, Adson test, Wright test, Eden test and Roos test. The diagnosis of this disease should be based on clinical symptoms and the results of the above tests, routine X-ray plain film, if necessary, vascular or brachial plexus angiography and neurophysiological examination.
6. Brachial plexus neuritis.
Acute or subacute onset, the first symptom is severe pain in one shoulder and upper limb, and may be accompanied by fever and other systemic symptoms.
7.Shoulder disorders.
Such as periarthritis of shoulder joint, rotator cuff injury, etc. Shoulder pain and movement disorders are the prominent symptoms. The two can be combined, and shoulder arthrography and MRI examination can help to make a clear diagnosis.
8. Neck-shoulder-arm syndrome.
The main symptom is the pain radiating from the neck to the shoulder, arm and fingers, which is related to the muscle fatigue caused by the bad posture of the cervical spine.
9.Cervical-shoulder-hand syndrome.
Also known as Steibrocker syndrome, manifested as abnormal autonomic function of the upper limbs, in addition to shoulder and finger pain, there is also finger swelling and color and temperature changes, followed by osteoporosis.
10. Upper limb peripheral nerve entrapment.
Such as carpal tunnel syndrome, ulnar tunnel syndrome and delayed ulnar nerve damage, etc. The diagnosis can mostly be clarified according to the corresponding symptoms, signs and neurophysiological examination. It should be noted that patients with cervical spondylosis may also have peripheral nerve entrapment in the upper extremity.