What is the next appropriate step for a 30-year-old female with neck and right arm pain, numbness, and tingling in the middle finger, and a positive Spurling test?

Management of Cervical Radiculopathy

Initiate naproxen therapy as the next appropriate step for this patient with cervical radiculopathy. 1, 2

Clinical Reasoning

This 30-year-old woman presents with classic cervical radiculopathy: neck pain radiating down the arm to the middle finger (C7 distribution), worsened by head turning, and a positive Spurling test. 1 The clinical diagnosis is clear without red flags requiring immediate imaging or specialist referral.

Initial Pharmacologic Management

NSAIDs like naproxen are first-line therapy for cervical radiculopathy pain:

• Nonsteroidal anti-inflammatory drugs are the appropriate first-line pharmacologic agent for mild to moderate pain in cervical radiculopathy 1, 2
• Acetaminophen is an alternative first-line option, but NSAIDs may be more effective for nerve root inflammation 2
• Most cases of cervical radiculopathy resolve spontaneously, with up to 75% showing improvement regardless of treatment type 1, 3

Why NOT the Other Options

Hydrocodone is inappropriate as initial therapy:

• Opioids are reserved for severe acute pain, not as first-line treatment 2
• The growing misuse and diversion of controlled substances necessitates caution even for short-term use 2
• This patient's pain responds to a heating pad, suggesting it is not severe enough to warrant opioid therapy 1

CT scan is not indicated at this stage:

• Imaging is not required unless there is trauma history, red flag symptoms (malignancy, myelopathy, abscess), or persistent symptoms after 4-6 weeks of conservative treatment 1
• This patient has only 10 days of symptoms with no red flags 1

Referral to pain management or orthopedic surgery is premature:

• The natural history of cervical radiculopathy is favorable, with most patients improving over time with nonoperative treatment 1, 4, 3
• Specialist referral is appropriate only after 4-6 weeks of failed conservative management or if red flag symptoms develop 1
• Surgical outcomes show 80-90% relief of arm pain, but surgery is reserved for failed conservative treatment or significant neurologic deficits 3

Comprehensive Treatment Plan Beyond NSAIDs

Additional nonoperative interventions to implement concurrently:

• Physical therapy involving strengthening and stretching exercises should be initiated 1, 4
• Short-term cervical collar use for immobilization may provide symptom relief 4
• Muscle relaxants can be added if muscle spasm is prominent 1
• Massage therapy may improve neck discomfort 1

Red Flags Requiring Urgent Imaging or Referral

Monitor for these concerning features that would change management:

• Progressive motor weakness or significant neurologic deficits 1, 3
• Signs of myelopathy (gait disturbance, bowel/bladder dysfunction, bilateral symptoms) 1
• Fever or constitutional symptoms suggesting infection 1
• History of malignancy 1
• Persistent or worsening symptoms after 4-6 weeks of conservative treatment 1

Follow-Up Strategy

Reassess at 4-6 weeks:

• If symptoms persist despite conservative management, obtain MRI to identify pathology amenable to epidural steroid injections or surgery 1
• Consider referral to orthopedic surgery or pain management if conservative treatment fails 1, 3
• Reassure the patient that the overall prognosis is favorable with nonoperative management 1, 4