From the Guidelines
A 39-year-old male with advanced multilevel degenerative disc disease and uncovertebral arthropathy at C3-C7 typically presents with chronic neck pain, stiffness, radicular arm pain, paresthesias, and possibly weakness in the upper extremities, as evidenced by the clinical presentation of cervical radiculopathy 1. The patient may report worsening pain with certain neck movements and activities, headaches extending from the neck, and decreased range of motion. Key symptoms to look out for include:
- Chronic neck pain
- Radicular arm pain
- Paresthesias
- Weakness in the upper extremities
- Worsening pain with certain neck movements and activities
- Headaches extending from the neck
- Decreased range of motion
Conservative management should begin with a multimodal approach including NSAIDs such as naproxen 500mg twice daily or ibuprofen 600mg three times daily for 2-3 weeks to reduce inflammation, as most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1. Physical therapy focusing on cervical stabilization exercises, postural correction, and gentle stretching should be prescribed for 6-8 weeks, with 2-3 sessions weekly. Activity modification to avoid aggravating positions is essential. For pain control, acetaminophen 1000mg three times daily can be used alongside NSAIDs. If pain persists, a short course of muscle relaxants like cyclobenzaprine 5-10mg at bedtime for 1-2 weeks may help. Some key conservative management strategies include:
- NSAIDs for inflammation
- Physical therapy for cervical stabilization and postural correction
- Activity modification to avoid aggravating positions
- Acetaminophen for pain control
- Muscle relaxants for short-term pain relief
- Cervical epidural steroid injections for persistent radicular symptoms
- Cervical collar for short-term relief during acute flare-ups, limited to 1-2 hours daily for 1-2 weeks to prevent muscle deconditioning.
From the Research
Clinical Presentation
- The clinical presentation of a 39-year-old male patient with advanced multilevel degenerative disc disease (DDD) and uncovertebral arthropathy at C3-C7 may include neck pain, radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities 2.
- The patient may also experience axial pain, which is the most common symptom of degenerative cervical disk disease 3.
- The clinical presentation can be grouped into axial pain, radiculopathy, and myelopathy, with varying degrees of severity and impact on daily life 3.
Conservative Management
- Conservative management of neck pain and radiculopathy typically involves a multimodal approach, including physical therapy, medications, and lifestyle modifications 2.
- Exercise treatment appears to be beneficial in patients with neck pain, and physical therapy may improve neck discomfort and reduce pain 4, 5.
- Cervical collars may be used for a short period of immobilization, and traction may temporarily decompress nerve impingement 2.
- Medications such as muscle relaxants and epidural corticosteroid injections may be used to alleviate pain and neuropathic symptoms, although the evidence for their effectiveness is limited 4, 2.
- A focused, nonoperative treatment course may lead to improvement in most patients with cervical radiculopathy, and treating patients with nonspecific neck pain within 4 weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy 2, 5.