Novel technique of diagnosing and reducing pain in cervical radiculopathy

Abstract

Background: Neck pain with upper limb pain is a common complaint of patients seen in Out Patient Department (OPD). Such pain may be because of a pinched nerve. There is inflammation in the nerve which causes radicular symptoms. The available clinical tests for cervical radiculopathy are provocative tests, difficult to perform and techniques vary from author to author. The reliability of these tests is only when done in clusters. We devised a novel non-provocative clinical sign to diagnose cervical radiculopathy and a method to reduce upper limb radicular pain and thereby improving the function of the upper limb. Method: Patient's bilateral pronated wrists were palpated dorsomedially on the ulnar styloid. This elicited tenderness over the Dorsal Cutaneous branch of Ulnar Nerve (DCU). The painless active degree of movement at shoulder and elbow joints was noted. Nerve block at the palpated tender point was given using 2% lignocaine in 95 patients. We used Visual Analogue Scale score to measure radicular pain intensity before and 5 minutes after injection. Results: All patients had tenderness at the DCU on the symptomatic upper limb. All patients had reduction in VAS of radicular pain from 7.36±0.89 before injection to 1.89±0.98 after injection with improvement of shoulder and elbow active movement. Conclusion:We recommend palpation of DCU in both upper limbs in all cases of suspected cervical radiculopathy. Palpation to elicit tenderness over DCU in cervical radiculopathy, was documented as Pote's sign positive. Injection of local anesthetic agent over DCU reduces pain and improves upper limb function and it was documented as Pote's test positive. This test is of diagnostic and therapeutic significance. This test is minimally invasive and can be done in an OPD set-up.

Effects of sustained natural apophyseal glides combined with transcutaneous electrical nerve stimulation in cervical radiculopathy

“…Cervical radiculopathy, commonly called a "pinched nerve" occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord [1]. This impingement typically produces neck and radiating arm pain or numbness or sensory deficits or motor dysfunction in the neck and upper extremities [2].…”