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A 49-year-old right-hand dominant female presents to an outpatient physical therapy clinic with a 3-week history of moderate neck pain radiating into her right shoulder and arm distally to the elbow. She reports having pain that began after an episode of sneezing. Recently, she rearranged her computer workstation, which she felt was contributing to her symptoms. Her past medical history is significant for cervical disc compression resulting from a figure skating accident at 18 years of age. In the examination room, the patient was seated and leaning back against the wall, holding her right arm on top of her head, with her head tilted forward and toward the left side. She reports that this position is how she has been sleeping in a reclining chair at home.

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What are the most appropriate physical therapy functional assessments for cervical spine dysfunction?

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What is her rehabilitation prognosis?

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What are the best provocation tests to assist with the diagnosis?

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Based on the case presented, what are the key signs and symptoms present?

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  • CERVICAL RADICULOPATHY: Neurologic condition characterized by dysfunction of a cervical spinal nerve, its roots, or both; usually presents with unilateral neck and arm pain with paresthesia, weakness, or reflex changes in the affected nerve root distribution
  • NECK DISTRACTION TEST: Clinical provocative test that attempts to unload a compressed nerve and lessen radicular symptoms in patients with suspected cervical radiculopathy; the patient lies supine and the therapist grasps under the chin and occiput, flexes the patient's neck comfortably, and gradually applies a distraction force; a positive test is the reduction or elimination of symptoms during neck distraction
  • SPURLING'S A TEST: Clinical provocative test used on patients with suspected cervical spondylosis or acute cervical radiculopathy; the patient is seated, the neck is passively laterally flexed toward the symptomatic side, and overpressure (~7 kg) is applied to the patient's head;1 a positive test is reproduction of the patient's symptoms
  • UPPER LIMB TENSION TEST A: Clinical provocative test that positions patient's neck and arm to relieve or aggravate arm symptoms; used in patients with suspected cervical radiculopathy

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  1. Describe cervical radiculopathy.

  2. Identify key questions to assist in the diagnosis of cervical radiculopathy.

  3. Identify the presence of red flags that would indicate the patient's problem is not musculoskeletal in origin.

  4. Identify reliable and valid outcome tools to measure cervical dysfunction.

  5. Discuss appropriate components of the examination.

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PT considerations during management of the individual with cervical radiculopathy:

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  • General physical therapy plan of care/goals: Relieve pain, improve neurologic function, prevent recurrence
  • Physical therapy interventions: Manual therapy; modalities (including cervical traction); postural re-education; neck muscle strengthening and stretching; ergonomic modifications, if necessary
  • Precautions during physical therapy: Constant or progressive pain that does not change with movement or position2; dizziness, vertigo, tinnitus, nausea, dysphagia; visual disturbances ...

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