Piva Cervical Radiculopathy Case

Question 1

What is the presence of cervical radiculopathy (CR) in the 5th decade of life and how many times more prevalent is it in this decade than other age groups?

Answer 1

2.03%. 3x more prevalent.

Question 2

What are some signs and symptoms of cervical radiculopathy?

Answer 2

unilateral motor and sensory symptoms into the UE: muscle weakness, sensory alteration, and reflex hypoactivity.

Question 3

True/False. The onset of CR is usually insidious in origin.

Answer 3

True

Question 4

What are the 2 most common causes of CR?

Answer 4

cervical disc lesions and osteophytic encroachment

Question 5

What 3 areas could limitation in neck flexion indicate problems with?

Answer 5

1. thoracic spine
2. cervicothoracic junction
3. cervical disc

Question 6

If, according to the algorithm, (fig 1) treatment (manipulation) to the thoracic and cervicothoracic spine doesn’t resolve the flexion, what is the next step?

Answer 6

Intermittent cervical traction

Question 7

If intermittent cervical traction shows improvement in neck flexion, then what do you do? If it doesn’t lead to improvement, what do you do?

Answer 7

Improvement: Continue till full flexion is attained.

No Improvement: refer out to get imaging done.

Question 8

If treatment (manipulation) of the thoracic spine and cervicothoracic junction restores flexion, what is the next step?

Answer 8

classify pt into opening or closing pattern of restriction.

Question 9

What is the difference between opening and closing restrictions?

Answer 9

Opening: present when symptoms are reproduced or increased during neck flexion, side bending, and rotation away from side of symptoms.
Closing: When symptoms are reproduced or increased during neck extension, side bending, and rotation toward the side of symptoms.

Question 10

What are the causes of opening and closing restrictions?

Answer 10

Opening: pathological factors limiting distraction of the zygoapophyseal joints during movements.
Closing: pathological factors limiting approximation of the zygoapophyseal joints during movements.

Question 11

If an opening restrictions are found, what do you check next? If closing restrictions are found?

Answer 11

Opening: If radicular S&S are present during movement or not.
Closing: If radicular S&S are present on closing.

Question 12

If no radicular signs or symptoms are found in a closing or opening restriction, what is the next step?

Answer 12

Opening or closing manipulation respectively.

Question 13

If radicular S&S are found on closing what do you check for next?

Answer 13

Presence or absence of neurological signs.

Question 14

If neuro signs are negative upon a positive radicular S&S on closing finding, what do you do next?

Answer 14

Opening Manipulation?

Question 15

If neuro signs are positive upon a positive radicular S&S on closing finding, what do you do next?

Answer 15

Traction Manipulation, then again check for radicular S&S on closing.

Question 16

If radicular S&S on closing are negative after traction manipulation, what do you do? If radicular S&S are positive what do you do?

Answer 16

negative: closing manipulation
positive: intermittent cervical traction in flexion.

Question 17

If radicular signs and symptoms are found during movement with an opening restriction, what is the next step?

Answer 17

Test for thoracic outlet syndrome (TOS).

Question 18

If a positive test for TOS is found with radicular S&S during movement, what do you do? If TOS test comes up negative?

Answer 18

positive: treat TOS
negative: check for radicular signs again.

Question 19

If radicular signs come up positive after a negative TOS test, what do you do? If they come up negative after a negative TOS test, what do you do?

Answer 19

positive: intermittent cervical traction
negative: opening manipulation

Question 20

Read the case study lots

Answer 20

and lots and lots.