Diagnosis and treatment of cervical radiculopathy using a clinical prediction rule and a multimodal intervention approach: a case series.
METHODS
Case series.


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Waldrop
Mark A
MA
Newberry Physical Therapy & Sports Medicine Clinic, Inc, Newberry, SC, USA. waldroppt@bellsouth.net
D000328:Adult; D002574:Cervical Vertebrae; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods; D011187:Posture; D011843:Radiculopathy / Q000175:diagnosis* / Q000628:therapy*; D014143:Traction; D016896:Treatment Outcome