Working Diagnosis:
Cervical Radiculopathy secondary to C7 Cervical Schwannoma

Treatment:
The patient successfully underwent C6/7 laminectomy with resection of intradural extramedullary tumor spinal tumor. The pathology report of this tumor confirmed a Schwannoma CNS WHO grade 1.

Outcome:
Upon presentation for 1 month follow up, the patient reported significant improvement of right arm radiculopathy. He still endorsed some neck stiffness and lingering right arm paresthesia but was no longer taking any pain medications. By the four month follow up, the patient reported complete resolution of pre-operative symptoms and was cleared for return to normal activity levels.

Author's Comments:
Schwannomas are rare, benign nerve sheath tumors, of which extracranial schwannomas comprise a rarer subgroup with one study finding a population-based incidence of head and neck schwannomas of 0.14 per 100,000 per year [1]. While usually asymptomatic, they can cause sensory loss, weakness, and radicular pain from compression of local neural structures [2]. Lesions originating from lower cervical roots can generate symptoms in both the periscapular region and the arm [3]. Given their rarity and nonspecific presentation, cervical schwannomas are often misattributed to more common musculoskeletal or radicular etiologies [4]. Recognition of atypical referred pain, especially persistent scapular pain refractory to conservative management, should prompt advanced imaging to ensure timely diagnosis.

Editor's Comments:
A learning point for this case is that cervical spinal lesions can manifest as scapular area pain, most commonly C7 lesions. In a review by Carmichael et al. [5] data analyzed from 86 studies from 1956-2022 found that “scapular pain is a common feature of cervical radiculopathy (72% of studies), ranking third behind neck (88%) and arm (85%) pain. Findings challenge the clinical assumption that arm symptoms are necessary for diagnosis, as evidence suggests scapular pain may precede arm pain by weeks. The C7 nerve root shows the strongest association with scapular pain.”

References:
1. Sinkkonen ST, Hildén O, Hagström J, Leivo I, Bäck LJ, Mäkitie AA. Experience of head and neck extracranial schwannomas in a whole population-based single-center patient series. Eur Arch Otorhinolaryngol. 2014 Nov;271(11):3027-34. doi: 10.1007/s00405-013-2871-8. Epub 2014 Jan 3. PMID: 24384632.
2. El-Sherif Y, Sarva H, Valsamis H. Clinical reasoning: an unusual lung mass causing focal weakness. Neurology. 2012 Jan 10;78(2):e4-7. doi: 10.1212/WNL.0b013e31824258af. PMID: 22232057.
3. Tanaka Y, Kokubun S, Sato T, Ozawa H. Cervical roots as origin of pain in the neck or scapular regions. Spine (Phila Pa 1976). 2006 Aug 1;31(17):E568-73. doi: 10.1097/01.brs.0000229261.02816.48. PMID: 16924193.
4. Uerschels AK, Dengler NF, Chihi M, Lenkeit A, Dinger TF, Jabbarli R, Sure U, Hagenacker T, Wrede KH, Gembruch O. Benign peripheral nerve sheath tumors: an interdisciplinary diagnostic and therapeutic challenge. Neurosurg Rev. 2023 Aug 18;46(1):205. doi: 10.1007/s10143-023-02107-z. PMID: 37594583; PMCID: PMC10439084.
5. Carmichael J, Weber KA 2nd, Rubinstein S, Svoboda E, Bade M. Scapular pain in cervical radiculopathy: A scoping review. N Am Spine Soc J. 2025 May 29;23:100619. doi: 10.1016/j.xnsj.2025.100619. PMID: 40620494; PMCID: PMC12226383.

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