Diagnosis for Neck Pain with Radiculopathy

(Includes NAD III and 'Specific' Classifications without Red Flags)

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Clinical Cornerstone: The goal is to identify the affected nerve root and determine the underlying cause to guide appropriate treatment. Diagnosis involves a thorough history and physical examination, focusing on neurological assessment. Imaging or diagnostic studies (e.g., MRI, electrodiagnostic studies) may be required when persistent, severe, or progressive neurological deficits are present.

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• Definition: Involves the irritation or compression of a nerve root in the cervical spine, manifesting as loss of reflex, weakness, or loss of sensation radiating down the arm, often following a specific nerve distribution. Radicular pain following a specific nerve distribution may be present.

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• Prevalence: Less common than non-specific neck pain (1-6/1000 persons).

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• Risk Factors: Include jobs that require lifting heavy objects, driving, operating vibrating equipment, older age, neck trauma, frequent diving from a board.

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• Pain Location: Typically originates in the neck and radiates down the arm, potentially as far as the hand, often following a specific dermatomal pattern.

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• Duration: Can be acute or chronic, with acute episodes potentially becoming recurrent or chronic if not managed appropriately.

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• Signs and Symptoms:

  • Sharp, shooting, or burning pain radiating down the arm, potentially associated with numbness, tingling, or weakness in the affected limb.

  • Pain may be exacerbated by specific movements such as bending the head forward, lifting, coughing, or sneezing.

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• Physical Examination:

  • Special Tests: Spurlings, Cervical Distraction, Bakody Sign. Positive test can indicate nerve root irritation.

  • Neurological Examination: May reveal sensory deficits, muscle weakness, and altered reflexes in the affected limb, corresponding to the involved nerve root.

  • Neurodynamic Tests: May be utilized to assess nerve root involvement.

  • Imaging: Imaging and advanced imaging can be used to guide alternative treatment options. Indications for imaging in the absence of trauma, suspected myelopathy, or red flags signs / symptoms  include: persistence or worsening of neck pain after four to six weeks of conservative care, progressive neurological symptoms, persistence of profound neurological symptoms after one week of conservative care, identified high-risk ligament laxity populations (e.g. active inflammatory arthritis, congenital disorders).

  • Electrodiagnostic Studies: Electromyography (EMG) and nerve conduction studies can be used to confirm a diagnosis of specific neck pain with radiculopathy. Indications may include persistent, progressive, or profound radiculopathy signs.

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• Response to Conservative Management: Can be variable, with some individuals responding well to conservative interventions like education , manual therapy, exercises , and medication, while others may require more interventional approaches, especially in the presence of persistent or severe neurological deficits.

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• Psychosocial Factors: Important to address psychosocial factors that may impact pain, disability, and recovery, such as fear of movement, beliefs about pain, and emotional well-being, ensuring a comprehensive management approach.