A practical approach for suspected cervical radiculopathy uses a small cluster of provocative, nerve-root–sensitizing tests at the bedside. The goal is to reproduce the patient’s radicular symptoms and localize irritation to a cervical nerve root, supporting degenerative foraminal compression from spondylosis. Upper limb tension tests check neural tissue sensitivity along the brachial plexus and nerve roots, so a positive result suggests nerve-root irritation rather than pure joint pain. Spurling’s test directly loads the foraminal space to provoke radicular pain when a compressed nerve root is present, helping localize the problem to neural impingement. The distraction test unloads the cervical spine and foraminal space; relief of symptoms with distraction strongly supports radiculopathy due to nerve compression rather than non-neurologic neck pain. A cervical range of motion limited to the ipsilateral side, particularly with rotation reduced to about 60 degrees or less, further points to mechanical impingement at the level affecting the nerve root. Together, these maneuvers form a useful initial screen because they are quick, noninvasive, and increase diagnostic confidence for nerve-root involvement before imaging. By contrast, signs like Lhermitte, Hoffman, or Babinski lean toward myelopathy or central nervous system involvement rather than radiculopathy, and imaging studies (MRI, CT, X-ray, ultrasound) provide structural information rather than a primary, bedside diagnostic cluster.

Facet syndrome is centered on the zygapophyseal (facet) joints themselves. These are the synovial joints between the superior and inferior articular processes of adjacent vertebrae. When they degenerate or become inflamed, the joint capsule and synovium generate most of the pain, especially with movements that load the facets—extension and rotation in the cervical region. The resulting pain is typically felt in the paraspinal area and may be provoked by specific extension-rotation maneuvers. The other structures are not the primary source in facet syndrome. The disc can cause axial or radicular pain from disc degeneration or herniation, but that’s a different pain generator. Uncovertebral joints and the lamina can contribute to other cervical pathology, but they are not the main structures involved in facet syndrome.

When external compression of the esophagus from cervical spine disease is suspected, the test of choice is a contrast esophagram (barium swallow). This study directly outlines the esophageal lumen while the patient swallows, revealing any indentation or narrowing caused by posterior cervical osteophytes, disc-osteophyte complexes, or retropharyngeal soft tissue. It provides functional and anatomic information about how the esophagus is being compressed, which helps confirm the diagnosis and gauge severity. While MRI or CT can show the cervical pathology and its relationship to the esophagus, they don’t visualize the esophageal lumen during swallowing as effectively as a barium swallow. Ultrasound isn’t useful for evaluating the cervical esophagus in this context.

The key idea is using an imaging study that directly visualizes neural structures within the spinal canal. MRI provides superior soft-tissue contrast, allowing clear visualization of the spinal cord, nerve roots, intervertebral discs, and surrounding ligaments. This makes it highly sensitive for detecting compression from herniated discs, foraminal stenosis, or other soft-tissue pathology, as well as any associated cord signal changes (myelopathy). X-ray mainly shows bone alignment and can't reveal neural elements. CT excels at bone detail but has limited soft-tissue resolution for neural structures. Ultrasound isn’t practical for evaluating the spinal canal. So MRI is the imaging modality of choice for assessing cord or nerve root compression.

Hangman fracture is a traumatic spondylolysis of the axis (C2) with bilateral fractures through the pars interarticularis and forward (anterior) displacement of C2 on C3. This pattern arises from a hyperextension injury to the neck, often with an axial load, which drives the posterior elements to fail on both sides of C2 and allows C2 to translate forward relative to C3. It’s a distinct mechanism from other cervical injuries: a Jefferson fracture is a burst of C1 from axial load, a base fracture involves the dens, and a facet fracture at a lower level involves the facet joints.