RCT of Multimodal Physiotherapy for Acute / Sub-acute Cervical Radiculopathy

Launched by ROYAL COLLEGE OF SURGEONS, IRELAND · May 19, 2015

Keywords

ClinConnect Summary

Cervical radiculopathy (CR) has been defined by the North American Spine Society (NASS) 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, with signs and symptoms including varying degrees of sensory, motor, and reflex changes in addition to dysaesthesia and paraesthesia (Bono et al. 2011). CR is of particular clinical concern, given the higher levels of pain and disability associated with the presence of nerve-related arm pain resulting in higher healthcare costs for this cohort of people with neck p...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Meets criteria for CR diagnosis on a clinical prediction rule (CPR) by demonstrating positive responses to at least 3 of the following 4 clinical tests: Spurling's Test, Upper Limb Neural Tissue Provocation Test 1 (ULNT 1), Cervical Distraction Test, and less than 60° of cervical rotation on the symptomatic side (Wainner et al., 2003).
• • Complaints of neck / periscapular pain, in addition to radicular pain, paraesthesia or numbness in the upper limb; aggravated by neck posture or movement (Thoomes et al., 2012).
• • Symptom duration must be greater than 2 weeks and less than 3 months.
• • Mean of Numerical Pain Rating Scale (NPRS) scores for both neck and arm pain must be ≥ 3/10.
• • Fluent in spoken and written English.
• • Willing to give informed consent.
• Exclusion Criteria:
• • Previous physiotherapy / manual treatment to cervical spine within past 6 months.
• • Previous epidural injection since the onset of current symptoms.
• • Prior surgery to the cervicothoracic spine or currently symptomatic upper limb.
• • Current symptoms \& signs of bilateral radiculopathy.
• • Myotomal paresis less than 4 / 5 on Medical Research Council Scale in affected upper limb.
• • Signs and symptoms suggestive of Cervical Spondylotic Myelopathy (CSM): bilateral paraesthesia, hyperreflexia, positive Babinski reflex and spasticity.
• • Diagnosis of any generalised neurological disorder e.g. multiple sclerosis.
• • Concurrent peripheral neuropathy affecting either upper limb e.g. carpal tunnel syndrome, thoracic outlet syndrome.
• • Medical red flags suggestive of serious pathology such as neoplastic conditions, upper cervical ligamentous instability, vertebral artery insufficiency and inflammatory or systemic disease (Childs et al., 2004).
• • Diagnosis of fibromyalgia.
• • Psychiatric diagnosis in past 6 months.
• • Ongoing litigation relating to cervical symptoms.