American Family Physician
Nonoperative Management of Cervical Radiculopathy
July 05, 2018 | Marc A. Childress, Blair A. Becker
Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary
to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits
and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease
in the cervical spine. The most common examination findings are painful neck movements and muscle spasm. Diminished
deep tendon reflexes, particularly of the triceps, are the most common neurologic finding. The Spurling test, shoulder
abduction test, and upper limb tension test can be used to confirm the diagnosis. Imaging is not required unless there is
a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess. Electrodiagnostic testing is
not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely
alternate diagnosis. Patients should be reassured that most cases will resolve regardless of the type of treatment. Nonoperative
treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal
anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks
of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment,
magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery.