Physio Penrith Cervical Radiculopathy Treatment
Treatment of cervical radiculopathy at Sydney Muscle & Joint Physio Penrith
What is cervical radiculopathy?
Cervical radiculopathy is a condition that presents in the neck and arm and can result from both acute posterolateral disc protrusions and from degenerative disorders. Cervical radiculopathy is defined as pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. Further, diminished muscle spindle reflexes (MSR) and some weakness should be seen in the upper limb. Radiculopathy should not be confused with radicular pain on its own, generally a true radiculopathy has these three signs and symptoms:
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Radicular pain and/or paraesthesia
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Diminished reflex
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Weakness or motor deficits
What are the symptoms of cervical radiculopathy?
Frequent signs and symptoms include neck, shoulder and arm pain varying degrees of sensory, motor and reflex changes as well as dysesthesias and paresthesias related to nerve root. In a study that looked at 736 patients with cervical radiculopathy, individuals reported the following symptoms: arm pain (99.4%), neck pain (79.7%), scapular (shoulder balde) pain (52.5%), anterior chest pain (17.8%) and headache (9.7%). Pain or paresthesia in a dermatomal pattern was reported by 53.9% of patients, while 45.5% experienced pain or paresthesia in a diffuse or non-dermatomal pattern. No pain or paresthesia was reported by 0.6% of patients. Of patients included in the study, 85.2% reported a sensory change to pinprick, 68% had a specific motor deficit and 71.2% had a specific decrease in a MSR (reflex).
How do you diagnose cervical radiculopathy?
The physiotherapists at Sydney Muscle & Joint Clinic use a diagnostic approach supported by research, in respect to cervical radiculopathy guidelines suggest the diagnosis of cervical radiculopathy be considered in patients with arm pain, neck pain, scapular or periscapular pain, and paresthesias, numbness and sensory changes, weakness, or abnormal deep tendon reflexes in the arm. These are the most common clinical findings seen in patients with cervical radiculopathy.
Further, it is suggested that the diagnosis of cervical radiculopathy be considered in patients with atypical findings such as deltoid weakness, scapular winging, weakness of the intrinsic muscles of the hand, chest or deep breast pain, and headaches.
Low quality evidence reports that provocative tests including the shoulder abduction and Spurling’s tests may be considered in evaluating patients with clinical signs and symptoms consistent with the diagnosis of cervical radiculopathy.
MRI is suggested for the confirmation of correlative compressive lesions (disc herniation and spondylosis) in cervical spine patients who have failed a course of conservative therapy and who may be candidates for interventional or surgical treatment.
Guideline-based treatment of neck pain with radiating pain?
For patients with cervical radiculopathy our physiotherapists offer mechanotherapy, which is the application of exercise to stimulate cellular healing, increase strength and stability and help with descending inhibition of pain. Epidural steroid injections, medications with physical therapy and the combination of both decreases arm and neck pain. With the rates of surgical procedures for cervical radiculopathy growing rapidly, more and more attention has been paid to non-surgical management options such as exercise. Exercise could increase neck flexor endurance and the cervical stabilisation. In addition, one study found exercise may activate conditioned pain modulation descending inhibitory pathways resulting in subsequent pain relief.
Passive interventions may also provide benefit in terms of pain reduction and mobility improvement in the form of joint mobilisations, soft tissue work, McKenzie directional preferenced movements and neurodynamic nerve stretching.
Interventional radiology may include transforminal or perineural corticosteriod injections and these may provide short-term pain relief. Surgical intervention is suggested for the rapid relief of symptoms of cervical radiculopathy and may include decompression or fusion.