From the Guidelines
The most appropriate next step in management for this 20-year-old female with episodic neck pain radiating to her right thumb is ibuprofen therapy and follow-up examination in 2 weeks. This patient likely has cervical radiculopathy secondary to muscle strain from overuse during painting, as suggested by the recent history of painting and the absence of red flag symptoms 1. Her symptoms are relatively acute (1 week), and she has no concerning neurological deficits, weakness, or bowel/bladder dysfunction that would suggest a more serious condition requiring immediate intervention.
Key Considerations
- The patient's age and lack of red flag symptoms, such as trauma, malignancy, or systemic diseases, make conservative management an appropriate first-line approach 1.
- Ibuprofen, a non-steroidal anti-inflammatory drug, will help reduce inflammation and pain while allowing time for natural healing.
- Conservative management is appropriate as first-line treatment for uncomplicated cervical radiculopathy, especially in young patients, as most cases resolve spontaneously or with conservative treatment measures 1.
Rationale for Not Choosing Other Options
- Electrophysiologic studies of the right upper extremity (Option A) and MRI of the cervical spine (Option B) are not immediately necessary without first trying conservative measures and observing the clinical course, given the lack of red flag symptoms and neurological deficits 1.
- Cervical epidural steroid injection (Option D) and operative repair of the cervical spine (Option E) are premature and more invasive options that would not be considered without first attempting conservative management and assessing the patient's response to treatment.
Next Steps
- If symptoms persist or worsen after two weeks of anti-inflammatory therapy, then further diagnostic workup with imaging would be warranted to rule out other potential causes of the patient's symptoms 1.
From the Research
Patient Presentation
The patient is a 20-year-old female college student presenting with a 1-week history of episodic neck pain that occasionally radiates to her right thumb. The pain is sometimes spontaneous and sometimes elicited when she coughs or laughs.
Symptoms and Examination Findings
- The patient has mild cervical paraspinal muscle spasms on the right
- Range of motion of the neck is moderately decreased
- No associated weakness, sensory symptoms, or bladder or bowel dysfunction
- The remainder of the examination, including neurologic examination, shows no abnormalities
Appropriate Next Step in Management
Based on the patient's presentation and examination findings, the most appropriate next step in management would be to start with conservative management.
- The patient's symptoms and examination findings do not indicate a need for immediate surgical intervention or advanced imaging studies at this time.
- Conservative management options may include physical therapy, pain management with medications such as ibuprofen, and follow-up examination to monitor the patient's progress.
Rationale for Conservative Management
- Studies have shown that cervical epidural steroid injections can be effective for short-term treatment of radicular pain 2, 3, but they may not be necessary as a first-line treatment for this patient.
- The patient's symptoms have only been present for 1 week, and it is possible that conservative management may be sufficient to resolve the issue.
- A follow-up examination in 2 weeks can help to determine if the patient's symptoms are improving or if further intervention is needed.
Options for Further Intervention
- If the patient's symptoms do not improve with conservative management, further intervention such as MRI of the cervical spine or electrophysiologic studies of the right upper extremity may be considered.
- Cervical epidural steroid injections may also be considered if the patient's symptoms persist and other treatments have been unsuccessful 4, 5, 6.