What you always wanted to know about the history and physical examination of neck pain but were afraid to ask

Honet, Joseph C.; Ellenberg, Maury

doi:10.1016/s1047-9651(03)00039-1

Cited by 24 publications

(8 citation statements)

References 31 publications

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“…There is no gold standard for the diagnosis of cervical radiculopathy, as clinical, radiological, and electrophysiological testing all have inherent limitations 11 . Although some consider the history and physical exam to be sufficient in many cases to make a clinical diagnosis, 12,13 others accept the criteria established by Radhakrishnan et al, 14 which combines the physical examination findings with advanced testing or surgical verification. However, in this study it was proven that clinical examination using the Spurling test yields high sensitivity and specificity, so only appropriate patients according to the physical findings can be further sent to imaging studies.…”

Section: Discussionmentioning

confidence: 99%

The Correlation between Spurling Test and Imaging Studies in Detecting Cervical Radiculopathy

Shabat

Leitner

David

et al. 2011

Journal of Neuroimaging

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Section: Discussionmentioning

confidence: 99%

The Correlation between Spurling Test and Imaging Studies in Detecting Cervical Radiculopathy

Shabat

Leitner

David

et al. 2011

Journal of Neuroimaging

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“…Quite clearly, future studies on this topic must somehow resolve this issue. Although some consider the history and physical exam to be sufficient in many cases to make a clinical diagnosis [18,28], perhaps the best practical solution to this problem might be to accept the criteria established by Radhakrishnan et al [43], which combines the physical examination findings with advanced testing or surgical verification.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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Clinical provocative tests of the neck, which position the neck and arm inorder to aggravate or relieve arm symptoms, are commonly used in clinical practice in patients with a suspected cervical radiculopathy. Their diagnostic accuracy, however, has never been examined in a systematic review. A comprehensive search was conducted in order to identify all possible studies fulfilling the inclusion criteria. A study was included if: (1) any provocative test of the neck for diagnosing cervical radiculopathy was identified; (2) any reference standard was used; (3) sensitivity and specificity were reported or could be (re-)calculated; and, (4) the publication was a full report. Two reviewers independently selected studies, and assessed methodological quality. Only six studies met the inclusion criteria, which evaluated five provocative tests. In general, Spurling's test demonstrated low to moderate sensitivity and high specificity, as did traction/neck distraction, and Valsalva's maneuver. The upper limb tension test (ULTT) demonstrated high sensitivity and low specificity, while the shoulder abduction test demonstrated low to moderate sensitivity and moderate to high specificity. Common methodological flaws included lack of an optimal reference standard, disease progression bias, spectrum bias, and review bias. Limitations include few primary studies, substantial heterogeneity, and numerous methodological flaws among the studies; therefore, a meta-analysis was not conducted. This review suggests that, when consistent with the history and other physical findings, a positive Spurling's, traction/neck distraction, and Valsalva's might be indicative of a cervical radiculopathy, while a negative ULTT might be used to rule it out. However, the lack of evidence precludes any firm conclusions regarding their diagnostic value, especially when used in primary care. More high quality studies are necessary in order to resolve this issue.

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“…In all of the patients in this study, a history of shooting pain and other related symptoms was associated with cervical radiculopathic disorder 9,10. A diagnosis of dropped shoulder causing lower cervical radiculopathy is based on a visually detectable dropped shoulder and is supported by two investigational findings.…”

Section: Discussionmentioning

confidence: 66%

Dropped Shoulder Syndrome: A Cause of Lower Cervical Radiculopathy

Abdul-Latif

2011

J Clin Neurol

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Background and PurposeCervical radiculopathy is a pathological process involving a nerve root of the cervical spine. The most common causes of radiculopathy are cervical disc herniation followed by cervical spondylosis. The aim of this study was to determine the effect of dropped shoulder as a cause of lower cervical radiculopathy.MethodsIn total, 132 patients, comprising 105 women (79.5%) and 27 men (20.5%; female : male ratio of 4 : 1) and a mean age of 36.7 years (range 18-58 years), were included in this study. All of the patients presented with shoulder pain, and were investigated by cervical X-ray, cervical magnetic resonance imaging, serum muscle enzymes, and electromyography (EMG)/nerve-conduction studies.ResultsNinety six patients (72.7%) exhibited visually detectable dropped shoulder. The lateral view X-ray of the cervical region revealed eight or more vertebrae. In 119 patients (90.2%), the EMG revealed a mild-to-moderate or moderate denervation patterns in the abductor digiti minimi, first dorsal interosseous, and flexor carpi ulnaris muscles, while the abductor pollicis brevis, extensor carpi radialis, and triceps brachii were denervated in 102 patients (77.3%). All of the patients had lower cervical paraspinal muscles with a denervation pattern.ConclusionsThree criteria for diagnosing dropped shoulder syndrome have been suggested: pain with consistent anatomical distribution, X-ray abnormalities, and EMG abnormalities. Compression of the cervical roots by muscle spasm has been proposed as the cause of dropped shoulder syndrome; this possibility is discussed herein.

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What you always wanted to know about the history and physical examination of neck pain but were afraid to ask

Cited by 24 publications

References 31 publications

The Correlation between Spurling Test and Imaging Studies in Detecting Cervical Radiculopathy

The Correlation between Spurling Test and Imaging Studies in Detecting Cervical Radiculopathy

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

Dropped Shoulder Syndrome: A Cause of Lower Cervical Radiculopathy

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