ClinicalPatterns.com: Cervical radiculopathy

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Symptom description

-Cervical region and medial scapular border pain (ache, stiffness, sharp, unilateral or bilateral) -Radiating or shooting pain into right arm along associated dermatome or non-specific pattern -Numbness and/or tingling in associated dermatome or overlapping -Weakness, heaviness, and/or fatigue in associated myotome or overlapping

Behavior (Aggravating factors)

-Prolonged sitting (computer work), cervical AROM (May have closing or opening pattern or gross restriction), overhead shoulder AROM, lifting and carrying, coughing/sneezing

Behavior (Easing factors)

-Lying down, sitting posture correction (including chin tucking), may have positional relief (i.e. placing involved arm on top of head or cervical spine extension), may have relief with NSAIDs or steroids

Special questions & Red flags -Clarify numbness and tingling symptoms if present (unilateral vs. bilateral). Bilateral hand (or LE) altered sensation occurring at the same time may indicate myelopathy. -Inquire about recent loss of balance, recurrent falls, and non-specific UE/LE weakness/heaviness (myelopathy) -Rule out shoulder, visceral sources

History

-Age: Peak incidence in 4th and 5th decade -Incidence: C5/C8 (low), C6 (low to mid), C7 (high) -May be traumatic onset i.e. s/p MVA or earlier history of trauma -May have gradual onset without injury i.e. cumulative trauma to disc from poor sitting habits of office worker -History of smoking

Objective signs & Special tests

-May have postural faults -Cervical AROM: Increased pain and/or restriction with movement toward involved side or non-specific pattern. Looking for reproduction of symptoms -(+) Neuro signs: sensation, DTR (hypo), myotome changes -(+) Cervical joint signs at level of injury, may have joint signs in gross cervical region and upper/mid thoracic spine -(+) ULTTA, Spurlings, and compression/distraction test

Treatment options

-May show directional preference and/or centralization i.e. chin tuck, extension, opening vs. closing position. If present, BEGIN TREATMENT HERE -Manual treatment: soft tissue techniques, joint mobilization (unilateral more than central PA’s if symptoms on one side), manipulation (usually not at level of involvement i.e. thoracic or upper cervical), traction (may be very effective if symptoms relieve during distraction test) -Progressive nerve tensioning exercise (manual and active) -Progressive deep cervical flexor strengthening and general cervical and thoracic stabilization. This may follow directional preference in early stages.