Acute low cervical nerve root conditions: symptom presentations and pathobiological reasoning

Abstract

Del Modelo Biomédico al Modelo Biopsicosocial: El desafío pendiente para la fisioterapia en el dolor musculoesquelético crónico. From the Biomedical Model to the Biopsychosocial Model:The pending challenge for physiotherapy in chronic musculoskeletal pain.

A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy

“…It is all the more interesting that various orthopaedic textbooks list these provocative tests as indicative or suggestive of a cervical radiculopathy [1-3, 13, 16, 56, 64], while there is so little evidence to support their accuracy. There are inherently two problems with trying to determine the accuracy of these tests for radiculopathy: (1) there are no universally accepted diagnostic criteria, and (2) it is not clear what a positive test actually measures. It is likely that these tests are not simply a measure of compression or traction of the nerve root (or dural sleeve).…”

“…A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) the diagnostic test was compared to any reference standard, such as, electromyography (EMG), plain film, or advanced imaging (e.g., MRI, CT, myelography); (3) sensitivity and specificity were reported or a 2 · 2 contingency table could be (re-)constructed; and (4) the publication was a full report. Case series and case reports, as well as animal, surgical, and cadaveric studies were excluded because these studies cannot evaluate diagnostic accuracy for subjects with neck and radiating pain.…”

Idiopathic Neuralgic Amyotrophy: An Illustrative Case Report

“…9 While nerve root disorders are often misdiagnosed or unrecognized, the emergence of the neurological signs as the condition progresses may lead to a misdiagnosis of cervical spine radiculopathy. 10 This differentiation is particularly important to avoid unnecessary investigations and inappropriate therapeutic or surgical interventions. 6 A key differential diagnostic feature is the provocation of pain or paresthesia with variants of cervical compression maneuvers.…”

Effektivität konservativer Behandlungsstrategien bei zervikaler Stenose - Pathophysiologie, klinische Präsentation und Evidenz für konservative Behandlung

“…Es kçnnen auch Symptome auftreten, die nicht in übersichtlichen dermatomalen Muster verteilt sind. Sogar Parästhesien folgen oft nicht dermatomalen Mustern [12,38]. Häufig betroffene Verteilungsbereiche bei Irritation der unteren Zervikalwurzel sind: Unterer Nacken, lateral bis zur Schulter, medialer Schulterblattrand sowie anteriorer Nacken bis zum oberen Brustbereich.…”

“…Oft ist kein Grund erkennbar, warum sich die Symptome verstärken oder nachlassen, aber in akuten Situationen führen folgende Maßnahmen manchmal zur Schmerzlinderung: E Schulterabduktion (Shoulder abduction relief sign [6]); E Von der schmerzenden Seite weg gerichtete Bewegungen zur Vergrçßerung des intervertebralen Foramens und gleichzeitiger Druckverminderung (Nackenflexion und -lateralflexion); E Kçrperhaltungen und Bewegungen in Richtung der schmerzenden Seite zur Verringerung der Spannung im neuralen Gewebe. Zu den ausgesprochen provokativen Haltungen, die dazu tendieren, vermehrten Druck auf die Nervenwurzel auszuüben, zählen: Lateralflexion/Rotation/seitliches Gleiten (Side flexion/rotation/ side gliding) in Richtung der schmerzenden Seite [12]. Bei einer neurologischen Untersuchung kçnnen sich Sensibilitätsverlust, Schwäche und Hyporeflexie finden.…”