![]() Opioid pain medications are not recommended for routine use, but they can be useful in managing radicular pain. Tricyclic antidepressants and drugs such as gabapentin are useful adjuncts in the treatment of cervical radiculopathy. The use of oral steroids should be limited to short-term due to controversies surrounding their use. Since the main cause of pain in cervical radiculopathy is inflammation, the use of non-steroidal anti-inflammatory drugs (NSAIDs) for 1 to 2 weeks can provide symptom relief and treat the proximate cause. Short-term use of a soft cervical collar can provide some relief. Nighttime use of a cervical pillow can relieve symptoms and make sleeping easier during recovery. Medical durable goods and appliances can provide significant symptom relief. In the setting of surgical intervention, physical therapy can speed recovery. However, to facilitate reduced nerve root inflammation and improve radiculopathy, it is important to implement non-surgical treatments, including oral anti-inflammatory drugs, physical therapy, and translaminar epidural steroid injections. An aggressive, well-designed physical therapy program can provide significant relief. Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8 to 12 weeks. Also, while surgery can provide significant relief, there is little evidence that surgery provides a clear advantage over non-surgical treatment in an acute setting. Treatment of cervical radiculopathy should be approached in a stepwise fashion. Selective nerve root blocks can provide short-term pain relief and confirm the nerve root origins of radiating pain. False positives are a risk in MRI studies.Įlectromyography is useful in confirming the dysfunction of the affected nerve root. While disc herniations and foraminal narrowing strongly correlate with radicular symptoms, they may not be causative in every case. MRI provides excellent visualization of soft tissue abnormalities, including disc herniations and nerve compressions. Magnetic resonance imaging (MRI) is the preferred modality for evaluating radiculopathies. Poor visualization of soft tissue makes CT less effective outside of this setting. Ĭomputed tomogram (CT) scanning may be helpful in the acute setting for diagnosing traumatic injuries resulting in radicular symptoms. Open mouth views are only necessary if disruption of the atlantoaxial joint is suspected. Oblique views may show foraminal narrowing at the level of radicular symptoms. Lateral views may show disc space narrowing. Plain x-ray studies of the cervical spine are commonly ordered for neck and upper extremity pain evaluation. In some cases, cervical traction can provide relief of radicular pain. The test is positive if the pain radiates down the upper limb of the ipsilateral side of the rotation. With the head extended, the head should then be rotated. The spurling test, which compresses the foramina, helps diagnose likely radiculopathy. Reduced muscle strength, innervated by the affected nerve, is a significant physical sign. If there is nerve impingement, the affected side is reduced relative to the unaffected side. Given the individual variation in deep tendon reflexes, comparing both sides of the neck is more important than overall magnitude. This helps accurately assess the patient's overall reflex response. When performing a physical examination, it is crucial to position the patient in a way that allows for the isolation of individual reflex arcs. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging, especially in cases of trauma. The history of patients with a complaint of radicular pain or muscle weakness should include inquiries about occupational risk factors, history of trauma, and pain patterns. Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. ![]()
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