MANAGEMENT OF CERVICAL RADICULOPATHY WITH MUSCLE WEAKNESS USING MULTIMODAL

APPROACH OF MANUAL THERAPY,

EXERCISES AND COGNITIVE BEHAVIORAL PRINCIPLES – A CASE REPORT.
Raghu Chovvath PT DPT OCS . Alternative rehab Inc. Livonia, MI.
Fellow - Regis University Manual Physical Therapy Fellowship Program
Manual Therapy Fellowship
Instructor – Institute Of Manual Physical Therapy - Orthopedic Residency Program
Treatment
Cervical radiculopathy is a Cervical Range of Motion Duration Of Treatment
debilitating condition that occurs 12 treatment sessions in 4 Weeks.
annually in 85 out of 100,000 Findings at D/C:
people2. Debility is worsened • Spurlings A ( - Ve)
AROM Initial D/C
further with associated muscle •ULTT ( -Ve) left
weakness. seventh cervical is the •ROM/ MMT/ Pain in charts
Flex 70° 90° •Triceps reflex absent.
most commonly involved nerve
root with resultant weakness of •GROC: 4wks 5+ / 16 wks 7+
Ext 30° 70°
triceps. •FABQ – pain – 0 , work- 0 at 16
This is a case report of a patient (R) Rot 50° 90° weeks
who presented with C7 •Back to all activities without
radiculopathy with triceps (L) Rot 70° 90° difficulty at work and at home.
weakness who was treated with Conclusion:
upper and middle thoracic Cervical radiculopathy is easier
manipulation, exercises and use to identify in the clinic with the
of cognitive behavioral principles Pain & Triceps muscle strength prediction rule . Multimodal
1

to decrease fear and anxiety. approach of management of this

Manual Traction though eased disorder has been described in
and alleviated symptom, triggered case series by different authors1.
patient’s dizziness of central This case study is unique with the
origin and hence intermittent two main factors namely the
cervical traction had to be intolerance to traction and
discontinued. significant fear and anxiety as
The Patient: noted by high FABQ scores .
•60 year old accounting Despite these limitation a course
employee. of treatment with manipulation to
•C/o pain in left upper trapezius the thoracic region, exercises and
and interscapular region. reinforcement using cognitive
•Constant & nagging in nature. behavior therapy principles
•Numbness in index middle and resulted in full muscle strength
ring finger. recovery by 4 wks and total
•Had local h/c injection in recovery of prior functional
rhomboids. abilities without any symptoms at
Reference:
•X-ray local degenerative changes 16 weeks follow-up.
•Neck Pain: Clinical Practice Guidelines. J Orthop Sports Phys Ther 2008;38(9):A1-A34.
in cervical region. This case report lends support
•Khalid M. Abbed, Jean-Valéry C.E. Coumans, Cervical
Findings on initial eval: to the fact that a thorough clinical
radiculopathy:pathophysiology,Presentation, and clinical evaluation. Neurosurgery 60[Suppl
• Kyphotic head forward posture decision making based on
1]:S-28–S-34, 2007.