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It would be suggested that he utilizes some of the over-the-counter pain medication to begin treatment.

If all those fail, then he should consult the GP to have a corticosteroid regime in place to bring down the radicular pain that he experiences.

He could also use NSAIDS under the guidance of the GP treating him and return for a check-up visit after those medications have been used for around two weeks, to see if the dosage provided is enough to reduce the pain in the long run.

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Steroid injections

Is performed on the patient under x-ray fluoroscopy. That is where the steroidal injection and the numbing agent are inserted into the epidural space of the spine.

The decrease in the pain present is sometimes temporary for a short period of time and as a result, multiple injections would need to be administered to achieve the desired outcome of reducing the pain levels

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It was mentioned that the evidence regarding this is of low quality explaining that NSAIDs has an overall improvement in the severity of the pain the patient presents with.

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This type of medication is typically recommended for individuals who don’t respond to physiotherapy treatment within four to six weeks.

The evidence supporting this treatment is of high quality.

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Vertebra above and below the damaged segment are fixed together so the joint becomes immobile
Spinal disc is also removed and replaced with bone or an artificial implant
Not ideal- last resort

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Surgery on the nucleus of the spinal disc/cervical corpectomy/percutaneous discectomy 

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Surgery on the nucleus of the spinal disc/cervical corpectomy/percutaneous discectomy 

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Indirect procedure to the nucleus of the affected spinal disc
Nucleus can be either suctioned out using a device known as a percutaneous nucleotomy or vaporized using a laser beam known as a laser discectomy
This type of surgery can only be completed if the outer layer of the disc is still completely intact

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Minimally invasive or keyhole surgery
Harder surgery
Can only be done when there is enough space to move muscles and structures
Long thin tube known as an endoscope to reach the damaged disc

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Larger incision is made and then the damaged part of the spinal disc is removed

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49yo M; ongoing (>three weeks) numbness, weakness, and pain in R) arm.

Longstanding bouts of neck pain and stiffness, which has been ‘OK’ until his current presentation.

radicular pain that starts R) side of neck & shoulder extending to the side and back of forearm down into the middle two digits.

Aggs: neck movements such as looking up.

P/E

decreased triceps reflex (seen in C7 radiculopathies)

weakness (C6 &C7;↓ El ext, ↓Wr ext)

altered sensation (↓ light touch).

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mimic in a radicular manner if a trunk of the plexus is affected

paraesthesia and flaccid paresis

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S/s

radiating pain from elbow into hand

numbness and/or tingling in 4th & 5th digits and medial aspect of hand; Agg by prolonged elbow flexion

difficulty w/ fine motor tasks

P/E

decreased sensation over ulnar side of hand

weakness in finger abductors and adductors (

‘claw hand deformity’

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Median neuropathy at the wrist

s/s:

pain radiating from wrist into hand, forearm  +/- shoulder

paraesthesia in digits 1 to 4 ; Agg by flex/ext of wrist

P/E

diminished sensation  palmar area of thumb, index & middle finger

atrophy of thenar eminence

weakness of APB

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No gold standard; MRI preferred choice

Indication:

persistent symptoms after conservative mx (4-6wks); possible sx candidate

suspicion of other sinister causes

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rest palm of affected side on top of head

+ve: relief of radicular pain

low-moderate sensitivity; moderate-high specificity

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Spurling manoeuvre (neck compression test)

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Spurling manoeuvre (neck compression test)

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ext & rotates neck to affected side, apply downward pressure on the head

posterior disc bulging, lateral flexion and rotation constrict the neural foramina

+ve: pain or paraesthesia

high specificity; low sensitivity

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Myotomal pattern?

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extensive overlap of dermatomes

well-demarcated sensory loss = peripheral nerve lesions, root lesions

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infectious processes

herpes zoster/ shingles

Lyme disease

malignancy,

nerve root infarction

nerve root demyelination

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Cervical spondylosis and/or lateral disc herniation

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Irritation of one or more Cx nerve roots

C6 & C7 most commonly affected

Features:

pain in the neck, shoulder and/or arm

muscle weakness

altered sensation

decreased dtr