3 expert tips for effective management of cervical radiculopathy

Neck pain is a common complaint encountered by physiotherapists. With approximately 85-95% of neck-related cases being “non-specific” in nature, true cervical radiculopathies are not the most common neck-related issue we see in the clinic. However, It’s important to stay up to date with the most relevant research to ensure you can correctly identify those cervical radiculopathies that do walk through your door, so you can manage them appropriately. Effective assessment and timely management of cervical radiculopathy can help your patient restore their function and get back to what they love quicker, while potentially reducing the risk of developing a chronic or recurring issue. Expert physio Erik Thoomes covers the best practice assessment and management of cervical radiculopathy in his comprehensive Masterclass – below are three key takeaways.

If you’d like to know how expert physio Erik Thoomes assesses and manages cervical radiculopathy, watch his full Masterclass HERE.

1 – History taking is key!

Objective measures for cervical radiculopathy are limited, so a good subjective assessment is integral in your differential diagnosis. Erik notes that cervical radiculopathies are often confused with Complaints of the Arm, Neck and Shoulder (CANS), which fall within the non-specific neck pain category and involve radiation of pain which usually occurs above the elbow. It’s important to remember that radiculopathies are not always painful, but when they are, the pain presents in a non-dermatomal pattern in approximately 70% of cases (1).

It’s particularly important to have a structured red flag screening process when assessing cervical complaints, so you can reduce the risk of missing serious pathologies which require referral on. Erik outlines his screening process including screening for things like night pain, specific unintended weight loss, history of cancer, constant non-mechanical pain, persistent fever, recent relevant trauma and long-term use of corticosteroids. These are just to name a few – see Erik’s Masterclass for a full run-down of what to look out for!

2 – Cluster your tests

Unfortunately there is no one special test to help diagnose cervical radiculopathy, but as mentioned above, hopefully you’ll have an idea of what you’re dealing with after a thorough subjective assessment. As with many conditions, it’s most useful to use a cluster of tests to provide an overall picture of the patient’s symptoms and function. Erik recommends clustering these tests:

• Spurlings test
• Traction/distraction
• Upper Limb Tension Tests (ULTTs)
• Arm squeeze test

Watch this snippet from Erik’s Masterclass in which he demonstrates how to complete the arm squeeze test:

For a positive ULTT, you’re looking for the reproduction of symptoms, a significant difference in range of motion between sides, or a change in symptoms with structural differentiation. A very useful little clinical tip from Erik is that if all four ULTTs are negative, you can confidently rule out cervical radiculopathy. Watch Erik demonstrate structural differentiation in the below video taken from his Masterclass:

If you have a positive cluster then you can use tests such as muscle strength (dynamometer), sensibility (e.g, sharp-dull, two-point discrimination) and reflexes to further add to the clinical picture. It’s important to note, Imaging is recommended only for people who have failed a course of conservative treatment and/or for those who may be candidates for injection or surgery.

3 – Timing matters!

Management decisions should be made based on the stage of the condition i.e., acute, subacute or chronic. For acute stages it’s important to provide treatments which aim to calm the pain down, including information and education, cervical “opening” mobilisations and exercises, sustained, pain-relieving positions, non-steroidal anti inflammatories, and – depending on the severity – potentially the short-term use of a cervical collar. See the below video from Erik’s Masterclass where he describes early stage management of cervical radiculopathy:

Treatment decisions will differ as the patient is in the subacute and chronic stages. For example, in the chronic stage, more generalised aerobic and strength training may be appropriate on top of motor control exercises, and hands-on therapy may become less relevant. Erik outlines each stage in-depth in his Masterclass, so be sure to check it out!

Wrapping up

Effective management of cervical radiculopathy requires a comprehensive approach that combines thorough history taking, clustering diagnostic tests, and timely intervention strategies. Recognising the differences between true radiculopathy, serious pathologies and other non-specific neck complaints is the crucial first step in appropriate management. With an expert-backed, systematic approach to assessment, and evidence-based management strategies, optimal outcomes can be achieved for your patients!

For a thorough understanding of the most up-to-date assessment and management strategies for cervical radiculopathy, watch Erik Thoomes’ full Masterclass HERE.