Cervical Radiculopathy: Difference between revisions
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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | |||
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Classification System for Neck Pain<ref>Childs JD, Fritz JM, Piva SR, et al. Proposal of a Classification System for Patients with Neck Pain. J Orthop Sports Phys Ther. 2004;34(11):686-700.</ref> | Classification System for Neck Pain<ref>Childs JD, Fritz JM, Piva SR, et al. Proposal of a Classification System for Patients with Neck Pain. J Orthop Sports Phys Ther. 2004;34(11):686-700.</ref> | ||
Proposal of Treatment-Based Classification System<ref>Fritz JM &amp;amp;amp;amp; Brennan GP. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Phys Ther. 2007;87(5):513-524.</ref> | Proposal of Treatment-Based Classification System<ref>Fritz JM &amp;amp;amp;amp;amp; Brennan GP. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Phys Ther. 2007;87(5):513-524.</ref> | ||
Prognostic factors for neck pain in the general population<ref>Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and Prognostic Factors for Neck Pain in the General Population. Spine. 2008;33(4S):S75-S82.</ref> | Prognostic factors for neck pain in the general population<ref>Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and Prognostic Factors for Neck Pain in the General Population. Spine. 2008;33(4S):S75-S82.</ref> | ||
Revision as of 13:02, 26 November 2010
Original Editor - Thomas Rodeghero, Stéphanie Dartevelle
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Original Editors
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Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Clinically Relevant Anatomy[edit | edit source]
add text here
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
add text here related to medical diagnostic procedures
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
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Medical Management
[edit | edit source]
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Physical Therapy Management
[edit | edit source]
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Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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Clinically Relevant Anatomy
[edit | edit source]
Cervical radiculopathy is defined as a disorder affecting a spinal nerve root in the cervical spine. Therefore, the most relevant anatomy is related to the cervical spine, such as the vertebral discs, facet joints, and the spinal nerve roots.
Mechanism of Injury / Pathological Process
[edit | edit source]
The most common cause of cervical radiculopathy are cervical disc herniations or other space-occupying lesions that impinge and/or cause nerve root irritation[1] The reported annual incidence of cervical radiculopathy is approximately 83 per 100,000, and increases to 203 per 100,000 in the fifth decade of life and beyond[2]
Clinical Presentation[edit | edit source]
The typical presentation of cervical radiculopathy is neck pain with associated upper extremity symptoms. Numbness and weakness in the upper extremities are commonly reported. Often, there is a decrease in cervical spine range of motion (ROM) with exacerbation of symptoms into the upper extremities with cervical movements. This also commonly results in a decrease in muscle length of the cervical spine musculature (upper trapezius, scalenes, levator scapula).
Diagnostic Procedures[edit | edit source]
The most common diagnostic method has been imaging studies (radiograph and MRI) and electrophysiologic studies (EMG)[3]. In 2003, Dr. Robert Wainner and colleagues examined the accuracy of the clinical examination and developed a clinical prediction rule to aid in the diagnosis of cervical radiculopathy. Their research demonstrated that these 4 clinical tests, when combined, hold high diagnostic accuracy compared to EMG studies: Positive tests for Spurling-A, Upper limb tension-A, and distraction sign along with cervical rotation of the involved side less than 60 degrees (see resources for more information regarding these tests). When all 4 of these clinical features are present, the post-test probablity of cervical radiculopathy is 90%.[4]
Outcome Measures[edit | edit source]
Neck Pain and Disability Scale
Management / Interventions
[edit | edit source]
There are several intervention strategies for managing cervical radiculopathy with physical therapy and surgical interventions being the most common. Long-term benefits of surgical interventions are questionable with reported numbers of 25% of people continuing to experience pain and disability at 12 month follow-ups[5]. There is a significant amount of evidence available to support the use of physical therapy interventions for patients with cervical radiculopathy, and the benefit of physical therapy and manual techniques in general for patients with neck pain with or without radicular symptoms (see key evidence for a list of references).
Regarding physical therapy interventions, in 2007 Joshua Cleland and colleagues examined the predictors of positive short-term outcomes in people with a clinical diagnosis of cervical radiculopathy. The following clinical features were found to be most predictive of a positive short-term outcome:
- Age <54
- Dominant arm not affected
- Looking down does not worsen symptoms
- Treatment involves manual therapy, cervical traction, and deep neck flexor strengthening for at least 50% of visits
If 3 of these features are present, the probability of success is 85%, and increases to 90% if all 4 are present[6]
Differential Diagnosis
[edit | edit source]
- Spinal Tumor
- Systemic diseases known to cause peripheral neuropathies
- Cervical myelopathy
- Ligamentous Instability
- Vertebral Artery Insufficiency (VBI)
- Herniated nucleous pulposos (HNP)
Key Evidence[edit | edit source]
The following are key evidence pieces for physical therapy interventions as they relate to both cervical radiculopathy and neck pain in general:
Manual therapy compared to 'usual' physical therapy and general practitioner care[7]
Clinical Practice Guidelines[8]
Classification System for Neck Pain[9]
Proposal of Treatment-Based Classification System[10]
Prognostic factors for neck pain in the general population[11]
Immediate effects of thoracic manipulation for patients with neck pain[12]
Clinical prediction rule for thoracic manipulation in patients with neck pain[13]
Resources
[edit | edit source]
CPR for cervical radiculopathy
CPR for traction for neck pain
Clinical Practice Guidelines for Neck Pain
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Radhakrishnan K, Litchy WJ, O'Fallon M, et al. Epidemiology of cervical radiculopathy: A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117:325-335.
- ↑ Ellenberg M, Honet J, Treanor W. Cervical Radiculopathy. Arch Phys Med Rehabil. 1994; 75:342-352.
- ↑ Partanen J, Partanen K, Oikarinen H, et al. Preoperative electroneuromyography and myelography in cervical root compression. Electromyogr Clin Neurophysiol. 1991; 31:21-26.
- ↑ Wainner RS, Fritz JM, Irrgang JJ, et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
- ↑ Heckmann J, Lang J, Zobelein I, et al. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. 1999;12:396-401.
- ↑ Cleland JA, Fritz JM, Whitman JM, et al. Predictors of short-term outcomes in people with a clinical diagnosis of cervical radiculopathy. Phys Ther. 2007;87(12):1619-1632.
- ↑ Hoving JL, Koes BW, de Vet HC, et al. Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. Ann Intern Med. 2002;136(10):713-722.
- ↑ Childs JD, Cleland JA, Elliott JM, et al. Neck Pain: Clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Assoction. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.
- ↑ Childs JD, Fritz JM, Piva SR, et al. Proposal of a Classification System for Patients with Neck Pain. J Orthop Sports Phys Ther. 2004;34(11):686-700.
- ↑ Fritz JM &amp;amp;amp;amp; Brennan GP. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Phys Ther. 2007;87(5):513-524.
- ↑ Carroll LJ, Hogg-Johnson S, van der Velde G, et al. Course and Prognostic Factors for Neck Pain in the General Population. Spine. 2008;33(4S):S75-S82.
- ↑ Cleland JA, Childs JD, McRae M, et al. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10:127-135.
- ↑ Cleland JA, Childs JD, Fritz JM, et al. Development of a Clinical Prediction Rule for Guiding Treatment of a Subgroup of Patients with Neck Pain: Use of Thoracic Spine Manipulation, Exercise, and Patient Education. Phys Ther. 2007;87(1):9-23.
