Neck pain is common and something we see in practice everyday. When upper extremity pain or neurological symptoms are also present, the clinical situation changes a little bit, requiring careful evaluation and an accurate diagnosis. This week, we get an update on the state of the literature regarding conservative management of cervical radiculopathy…
Cervical radiculopathy can result in pain, sensory loss, and/or muscle weakness, significantly impacting a person’s quality of life. Conservative interventions are typically first-line treatment, with many patients reporting symptomatic improvements. However, current reviews evaluating conservative management for cervical radiculopathy have various limitations, such as the date they were completed and the exclusion of relevant comparator groups.
The objective of this review was to identify, appraise and synthesize the evidence on the effectiveness and safety of conservative interventions for the management of adults with cervical radiculopathy.
From Dr. Thistle:
Where does this leave us as clinicians? As with many clinical conditions, there is a paucity of high, or even moderate quality evidence on which we can base clinical recommendations for cervical radiculopathy. With that said, the trends in the existing studies (mostly of lower quality) points to the potential benefits of acupuncture, SMT (cervical and/or thoracic) and laser for these patients. Regarding SMT, the decision of whether to employ this method of treatment is one to make with your patient after a careful and comprehensive intake evaluation. Take into consideration their experience with manipulation (i.e. have they been adjusted before?), the temporality and severity of their symptoms (i.e. is this patient at risk of worsening their neurological deficits?) and your clinical intuition as to whether SMT might help them (have you considered mobilization first to assess their movement/force tolerance?). There are lots of factors to consider, but a trial of care while consistently evaluating response to care and the patient’s neurological status seems to be a reasonable approach as we await higher quality trials.
This week’s Research Review: “Conservative Management of Cervical Radiculopathy”
This paper was published in the Clinical Journal of Pain (2023)
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