ClinicalPatterns.

com: Cervical radiculopathy

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Symptom description

Behavior (Aggravating factors) Behavior (Easing factors) Special questions & Red flags

History

Objective signs & Special tests

Treatment options

-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 -Prolonged sitting (computer work), cervical AROM (May have closing or opening pattern or gross restriction), overhead shoulder AROM, lifting and carrying, coughing/sneezing -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 -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 nonspecific UE/LE weakness/heaviness (myelopathy) -Rule out shoulder, visceral sources th th -Age: Peak incidence in 4 and 5 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 -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 -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 PAs 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.