From the Research
The treatment for a patient with a positive Spurling test to the right upper extremity should prioritize a multimodal approach, focusing on pain control, physical therapy, and activity modification, with consideration of the most recent and highest quality evidence from 1, which suggests the effectiveness of sustained natural apophyseal glide (SNAG) combined with neurodynamics in managing cervical radiculopathy. The initial management should focus on pain control with NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as well as muscle relaxants like cyclobenzaprine (5-10mg three times daily) for associated muscle spasm. Physical therapy is essential and should include cervical traction, postural education, and specific strengthening exercises for the cervical spine and scapular stabilizers, typically 2-3 sessions weekly for 4-6 weeks, with consideration of the patient's response to the Spurling test as indicated in 2. Activity modification is important, with patients advised to avoid positions that exacerbate symptoms, particularly neck extension and lateral flexion toward the affected side. For moderate to severe pain, a short course of oral corticosteroids (e.g., prednisone taper starting at 60mg daily and decreasing by 10mg every 2 days) may be considered, as supported by the general approach to managing cervical radiculopathy. If conservative measures fail after 6-8 weeks, epidural steroid injections might be appropriate, with the understanding that the Spurling test's sensitivity and specificity for cervical radiculopathy, as discussed in 3 and 4, guide the decision-making process. Surgery is reserved for patients with progressive neurological deficits or persistent symptoms despite comprehensive conservative management, emphasizing the importance of a thorough evaluation and consideration of the patient's overall clinical presentation, as highlighted in 5.
Key considerations in the treatment approach include:
- The use of SNAG combined with neurodynamics as a potentially effective conservative management strategy for cervical radiculopathy, as suggested by 1.
- The importance of physical therapy in addressing cervical radiculopathy, including exercises and modalities that target the cervical spine and scapular stabilizers.
- The role of activity modification in managing symptoms and preventing exacerbation of the condition.
- The consideration of oral corticosteroids for moderate to severe pain, with careful monitoring of the patient's response and potential side effects.
- The potential for epidural steroid injections in cases where conservative measures are insufficient, with careful patient selection based on clinical presentation and response to prior treatments.
- The reservation of surgical intervention for cases with progressive neurological deficits or persistent symptoms despite comprehensive conservative management, emphasizing the importance of a multidisciplinary approach to patient care.