cervical radiculopathy

[gcoe]

Hi Sharadphysio

Sounds like you are generally proceeding through things logically. The fact that you get temporary relief seems significant to me. Only thing is point number 3. It looks to me like you may have dropped the ball here. As the improvements were dramatic even if just temporary maybe you need to unpackage this. Did you combine both lateral glides + neural mobs from the start? If so that wasn’t very logical. Did you only do the combination of lateral glides + neural mobs once? From what you have written it isn't clear if it was the lateral glides or the neural mob that improved matters (or if it was both). Maybe you should go back to just applying the lateral glides, see if you get an improvement just with this and apply a few times. If you don't get an immediate response then you know that probably wasn't easing technique. Then you could work on just applying the neural mob, but do it several times and do it yourself rather than self stretches. In short: refine your detective work so you can identify the technique that may likely provide the most benefit on reapplication and progression.

A couple of things to consider:

Do you think the radiculopathy has an inflammatory component (Go back to your 24hr behaviour and irriatbility). If yes this may be why it isn't settling. The mechanical therapy is providing a temporary space for the nn root but on release of the technique several hours/day or two later their is mechanical irritation of the inflamed nn root.

Are you sure the paraesthesia and numbness is due to nerve conduction problems? the positive ULTT with radial bias would suggest that. However think about the dermatome. Does this match? There is no frank weakness, Is the numbness both subjective and objective? If only subjective could it be epiphenomena eg. trigger point or autonomic as in T4 syndrome? If so the temporary response to treatment might be more due to the pain gate mechanism rather than mechanical effects. So why don’t you go back and really confirm your neuro signs

Do we have an opinion from a MSK physiotherapist who may be more on to it than me?

[sharadphysio]

thanx gcoe for ur prompt response
u mentioned some points
like trigger point....since the pt is getting symptoms in palm and also there is radiation component present ,i doubt it could be becoz of trigger point??
2)u mentioned to check with dermatome!!!clinically and subjectively pt has c5,c6,c7 and c8 dermatome involvement mainly parasthetias.
3)inflammatory component!!
had it been inflammtory it could have been more irritable????? but for me it seems moderately irritable (between irritable and non irritable)...as pt has been doing neuro tissue mobi successfully.....without provoking with progression of stretches
my queries over ur comment---
as i have mentioned in previous note pt has severe degenerative changes in cx spine x ray so how much we can go with cx mobi?
secondly,i mentioned in the previous note,pt gets tigling with neck isometric contractions??i tried with towel exr....when i tried with pressure feed back with mild contractions so symptoms but with vigorous contractions she gets the same???? so i m a litle confused about the region of involvement i mean primary....whether upper cx is primary or lower cx ?????

ur take on this

thanx