Diagnosis and Treatment of Cervical Radiculopathy Using a Clinical Prediction Rule and a Multimodal Intervention Approach: A Case Series

Abstract

Study Design: Case series. Objectives: To describe an established method of diagnosing cervical radiculopathy (CR) using a clinical prediction rule (CPR), and to describe the management of 6 patients using intermittent cervical traction (ICT), thoracic thrust joint manipulation (TJM), and exercise. Background: Many patients present with unilateral arm pain without having undergone magnetic resonance imaging (MRI) of the cervical spine. Using a CPR has demonstrated high levels of specificity to rule in cervical radiculopathy. ICT and manual therapy (including thoracic TJM) are widely used in clinical settings to treat cervical radiculopathy. Case description: Six patients (3 men, 3 women) were diagnosed with cervical radiculopathy using the CPR. All patients were treated with ICT, thoracic TJM, and exercise. The Northwick Park Neck Questionnaire served as the outcome measure. Outcomes: The CPR accurately identified CR (secondary to a disc herniation) in 4 out of 4 patients when compared to the results of a reference standard (MRI). Six patients were seen from 5 to 18 sessions over a 19-to 56-day period. Reduction in Northwick Park Neck Questionnaire scores ranged from 13% to 88%. One patient did not improve significantly and underwent neck surgery. Discussion: Using the CPR may be beneficial in diagnosing CR, so the clinician can devise a plan of care and assess treatment outcomes in a relatively homogenous group of patients. It is possible that a treatment regimen of ICT, thoracic TJM, and exercise will aid in centralizing radicular symptoms and improving functional outcomes in patients with CR. J Orthop Sports Phys Ther 2006;36:152-159.

Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

“…While preliminary reports suggest that a multimodal treatment program consisting of manual therapy and exercise may result in positive outcomes for patients with CR, [6][7][8][9][10] efforts to successfully add cervical traction to a multimodal treatment program remain elusive. A study by Ragonese 11 concluded that when treating patients with a diagnosis of CR, an approach that combines manual therapy (including cervical traction) and therapeutic exercise appears to be superior to either intervention alone.…”

Specificity in Retraining Craniocervical Flexor Muscle Performance

“…As the head is lifted against gravity, the CCF muscles are trained in their capacity to prevent gravity-induced craniocervical extension, as indicated by a forward thrust of the chin. 2,9,37 Although both craniocervical flexion and cervical flexion movements utilize the CCF muscle group, 27 there are fundamental differences between these exercises. Specifically, craniocervical flexion occurs principally about the upper cervical motion segments, 10,34,38 while cervical flexion, although involving multiple cervical motion segments, can be primarily resolved to motion about the cervicothoracic junction.…”

The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…Figure 1 illustrates the results of search strategy for potential articles. Following the initial exclusion of articles from database searches and after a review of potentially relevant articles obtained from database searches, manual searches, and authors, 21 obtained articles were excluded for the following reasons: case study/series 3,6,9,15,20,23,35 , use of mobilization instead of manipulation [36][37][38][39] , purpose being biomechanical/ physiological documentation 30,40,41 , cohort designs 11,12 , primarily informational 42,43 , one group pretest/post-test design 5 , follow-up of a previous RCT 44 , or subjects were younger than 18 years of age 45 . Eight authors were identified and emailed to find out if they were aware of other articles on TSM.…”