Neck pain with radiating pain

Question 1

What are some common symptoms of those with neck pain with radiating pain?

Answer 1

• neck pain with radiating pain in the involved extremity
• upper extremity dermatomal paresthesia or numbness, and myotomal muscle weakness

Question 2

What are some expected exam findings?

Answer 2

• neck and neck related radiating pain reproduced or relieved with radiculopathy testing (using the cluster of tests)
• may have upper extremity sensory, strength, or reflex deficits associated w/ the involved nerve roots

Question 3

What is the cluster of tests for cervical radiculopathy and what is the data?

Answer 3

• ULTT 1
• Spurling’s test
• Cervical distraction
• Cervical ROM

Sp when all 4 are (+) = .99 (LR=30.3)
Sp when 3 are (+) = .94 (LR=6.1)

Question 4

What shoulder be included in an exam?

Answer 4

• neurological screen
• neurodynamic testing (ULTT 1 most important)
• Spurling’s test
• Neck distraction test
• Valsalva test (as long as vitals okay)

Question 5

What is Sn & Sp of ULTT1?

Answer 5

Sn: .97
Sp: .27

HELPS rule OUT if negative

Question 6

What is Sn & Sp of Spurling’s test?

Answer 6

Sn: .30-.50
Sp: .86-.93

HELPS rule IN if positive

Question 7

What is Sn & Sp of distraction test?

Answer 7

Sn: .44
Sp: .90

HELPS rule IN if positive
alleviation of symptoms = positive

Question 8

What is Sn & Sp of Valsalva test?

Answer 8

Sn: .22
Sp: .94

HELPS rule IN if positive

Question 9

What are some interventions for the acute stage of radiculopathy?

Answer 9

• mobilizing and stabilizing exercises
• low-level laser
• possible short use of cervical collar

make appropriate referrals if s/s are not resolving or are worsening

Question 10

What are some interventions for the chronic stage of radiculopathy?

Answer 10

• intermittent cervical traction
• combined exercise and manual therapy
• education and counseling
• use of upper quarter nerve mobilization (glides/slides/flossing)

Question 11

What are the parameters for intermittent cervical spine traction?

Answer 11

• 5-10 minutes
• either 60/20 or 30/10 on/off time (seconds)
• MAX pull = 10-25lbs
• MIN pull = 50% of max pull

Question 12

What is the CPR for cervical traction?

Answer 12

Individuals w/ 3/5 of the follow are highly likely to benefit from cervical traction:
- peripheralization of symptoms w/ lower cervical mobility testing
- (+) shoulder abduction sign
- (+) cervical distraction test
- (+) ULTT
- 55 years or older