Any topic (writer’s choice)
Discussion 12.1: Musculoskeletal Case Study
1. Please provide a discussion post regarding your classmate post and look at the
Case study to provide the best discussion for this Musculoskeletal case.
“Cervical radiculopathy is a common clinical scenario and typically presents with unilateral neck pain, arm pain, or both. Patients may also present with neurologic signs such as sensory or motor deficits. It is important to differentiate cervical radiculopathy from other items on the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. Cervical radiculopathy is a clinical condition resulting from compression of cervical nerve roots. The clinical manifestations of cervical radiculopathy are broad and may include pain, sensory deficits, motor deficits, diminished reflexes, or any combination of the above. Similarly, there are a variety of different pathophysiologic processes which may result in dysfunction of the cervical nerve roots.
The pathoanatomy of cervical radiculopathy involves compression of the cervical nerve root . Compression of the cervical nerve root may occur due herniation of disk material or bony osteophytes that impinge on the cervical nerve root. Epidemiologic studies have shown that the C7 root (C6-7 herniation) is the most commonly affected, followed by the C6 (C5-6 herniation) and C8 (C7-T1 herniation) nerve roots ( Iyer & Kim, 2016).
Most cases of cervical radiculopathy are self-limited and may be managed conservatively in the absence of progressive neurologic symptoms or other concerning symptoms such as osseous lesions. There are several options for conservative management, but there is little evidence to suggest that any of these interventions substantially alter the natural history of the disease. While exact surgical indications have not yet been elucidated, surgery may be considered in patients that have not responded to conservative management at about 6 months.
Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids or non-steroidal pain medication like ibuprofen or naproxen and physical therapy. Left untreated, patients with cervical nerve root compression can lose function in an affected arm. Improvement may occur immediately or within two weeks, depending on the patient and the cause of the radiculopathy. Some patients will respond after one injection, but others may require up to three, interspersed over the course of a recovery period of one to three months. The longer that numbness and/or weakness lasts in the shoulder, arm, or hand, the more likely that these deficits will become permanent or lead to paralysis.
An accurate history is a critical first step in the diagnosis of radiculopathy. Examiners must focus on the location and patterns of pain, paresthesias, sensory deficits, and motor deficits. In most cases, cervical radiculopathy can be diagnosed based on the patient history alone. Non-operative treatment of cervical radiculopathy consists of a number of different modalities including immobilization, physical therapy, traction, manipulation, medication, and cervical steroid injection . Authors have reported good to excellent outcomes in up to 90 % of patients with non-operative management of cervical radiculopathy (Iyer & Kim, 2016).
A well-designed physical therapy program should progress the patients through these stages as pain improves, beginning with gentle range of motion exercises, and adding strengthening and conditioning activities once the acute symptoms subside . Finally, physical therapy programs should include some component of postural and ergonomic training.
There is low-quality evidence that surgery may provide pain relief faster than physical therapy or hard-collar immobilization in CR, but there is little or no difference in the long-term. Surgery may be associated with a 4% adverse events rate.Therefore, conservative management is the initial treatment of choice for most patients with CR, even though patients should be referred to a spine surgeon in the presence of intractable radicular symptoms unresponsive to nonoperative management over a 6-week period, motor weakness persisting for more than 6 weeks, progressive neurologic deficit at any point after symptom onset, signs or symptoms of myelopathy, and spinal instability or deformity ( Romeo et al., 2018).
I also include more education about how properly use the medication and side effects of these medication , especially ibuprofen to be taken with foods to prevent risk of gi distress , PUD and gi bleeding. Education about side effects of steroid need to be included in education plan of the patient and all questions need to be addressed by end of the visit , so patient be comfortable with plan of care.”
References:
Iyer, S., Kim, H. J. (2016). Cervical radiculopathy. Current reviews in Musculoskeletal medicine. 9(3): 272-280. doi: 10.1007/s12178-016-9349-4 (Links to an external site.)
Romeo, A., Vanti,C., Boldrini, V., Ruggeri, M., Guccione, A.A., Pillastrini, P., Bertozzi, L. (2018). Cervical Radiculopathy: Effectiveness of Adding Traction to Physical TherapyA Systematic Review and Meta-Analysis of Randomized Controlled Trials . Physical Therapy. Volume 98, Issue 4. p 231242. https://doi.org/10.1093/physth/pzy001. (Links to an external site.)
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