Cervical Radiculopathy

Transcription

1 Cervical Radiculpathy Anatmy and Bimechanics The neck r cervical spine is cmprised f seven vertebral bnes stacked in a clumn which supprt the head. In between each f the vertebrae is an intervertebral disc. The spinal crd travels dwn inside f the cervical spine in a bny cage. Arising frm each vertebral level n each side f the crd are nerve rts which exit ut thrugh hles in the cage and travel dwn t the neck, upper back, and arms. These small hles thrugh which the nerves exit are called framen. The ceiling f each hle is made by the vertebrae abve and the flr f the hle is made by the vertebrae belw. Cervical radiculpathy is a painful cnditin in which a nerve becmes pinched as it leaves the spinal crd. The pinched nerve is cmpressed by either herniated disc material r by degenerative bny spurs arising frm the neck. 1 The nerves travel int yur neck, upper back and arms, and can refer symptms int these areas. Symptms experienced can be pain, numbness, tingling, weakness r a cmbinatin f these. Treatment Optins Effective treatment f radiculpathy begins with a thrugh examinatin t determine the rt cause f the dysfunctin. Once the exam and diagnstic prcess is cmplete yur physician will wrk with yu t determine the mst apprpriate curse f actin fr treatment. In mst cases cervical radiculpathy is first treated cnservatively. This may include rest, anti-inflammatry medicatin, and activity mdificatin. Yur dctr may refer yu t physical therapy t wrk n reducing the cmpressin and inflammatin f the nerves in yur neck. If the pain in yur neck and arm des nt reslve with these cnservative measures yur dctr may recmmend yu t have an injectin f antiinflammatry medicatin (crtisne) directly int the regin f nerve cmpressin. This space is ften referred t as the epidural space and the injectin is smetimes referred t as an epidural injectin. This can be a very effective treatment fr reducing the inflammatin enugh t allw physical therapy treatment t wrk effectively. Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 1

2 In sme instances cervical radiculpathy is resistant t all frms f cnservative treatment. In these cases yu and yur dctr may decide that surgical management f the pain is the best ptin. This prcedure may include remval f the herniated disc material r bne spur t free the nerve frm the cmpressin. Prir t underging surgery yur dctr will discuss the prcedure and recvery prcess in detail. Rehabilitatin Philsphy The gals f physical therapy are t reduce the nerve cmpressin, decrease pain, and restre functin. Currently the best apprach t treatment invlves multiple treatment strategies. Manual and/r mechanical tractin may be applied t yur neck t unlad the cmpressed nerve. Different mdalities utilizing heat r electrical stimulatin may be used t reduce pain and decrease muscle guarding. Hands-n manual techniques will be emplyed t lsen stiff neck and upper back jints and muscles t help t maximize flexibility. 2 Restring strength t the deep stabilizing muscles in the frnt f yur neck and between yur shulder blades will imprve yur pstural endurance which is needed t avid future aggravatin f the nerve. 3 Rehabilitatin **The fllwing is an utlined prgressin fr rehab. Advancement frm phase t phase as well as specific exercises perfrmed shuld be based n each individual patient s case and sund clinical judgment by the rehab prfessinal. ** Phase 1: ACUTE PHASE Gals Reduce pain and inflammatin Prtect injured nerve and cervical spine Imprve cervical range f mtin () withut an increase in radicular symptms Imprve thracic Imprve psture Recmmended Exercises Active cervical within a pain-free range Active thracic Scapular retractin exercises Pectral stretches Length wise fam rller use with head supprted *Perfrm exercises gently with the gal f reducing muscle guarding and pain If tlerated, deep neck flexr muscle activatin is t be initiated Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 2

3 Guidelines fr Prgressin Befre prgressing t the subacute phase the neck and radiating symptms shuld be less painful at rest and with mvement. Increased pain with passive shuld be seen mre at end range and less with initiatin f mvement. Deep neck flexr activatin shuld be achieved. The patient shuld have a gd knwledge f pstural crrectin techniques and activities that alleviate symptms. Phase 2: SUBACUTE PHASE Gals Cntinued prtectin f injured/healing tissue Increased passive and active in the cervical and thracic spines Increased strength f cervical and periscapular musculature endurance with lnger duratin hlds Decrease axial symptms Ablish radicular symptms Precautins Avid any activity r exercise that reprduces radicular symptms. Recmmended Exercises Active cervical wrking tward end range Active thracic wrking tward end range Scapular retractin exercises with resistance Pectral stretches Cntinue lying ver a fam rller with head supprted : (lw resistance and lng duratin hlds) Deep neck flexrs Neck extensr strengthening Guidelines fr Prgressin Reslutin f radicular symptms Mild axial cervical pain may remain The patient shuld have gained a majrity f their available back Gd tlerance fr strengthening (-) Spurlings test (-) ULTT Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 3

4 Phase 3: REHAB PHASE Gals Cntinue t acquire nrmal if still deficient Prgressively cntinue t strengthen peri-scapular muscle grups with increased resistance Restre functinal use f arm and neck Precautins Avid any activity r exercise that reprduces radicular symptms. Recmmended Exercises Stretches t cervical spine musculature Cntinue with thracic mbility exercises Cntinue with pectral stretching (Theraband r Dumbell) T, Y, and I prgressin (shulder extensin/ hrizntal abductin/scaptin) Cervical ismetrics in all planes Guidelines fr Prgressin Befre prgressing t the sprts specific phase the cervical spine shuld be pain free in all planes f mtin and strength shuld be very gd. Neck and arm symptms shuld be gne. Phase 4: SPORT SPECIFIC PHASE Gals Restre nrmal and strength Cntinue t encurage cervical spine use fr functinal activity and return t sprt Limitatins Encurage slw prgressin back t sprt and high level activity Wrk with rthpedic dctr r physical therapist regarding specific plan fr return t sprt/activity Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 4

5 Recmmended Exercises and Stretching Cntinue with phase tw and three exercises as directed by physical therapist Cntinue with phase three strengthening 2-3 times a week. Wrk with physical therapist t determine which exercises shuld be cntinued Guidelines fr Return t Activity Wrk with physician r physical therapist fr specific plan fr return t sprt and activity. Step by step prgressins shuld allw fr gradual return t high level activities. Phase Fcus Range f Mtin Recmmended Exercises Precautins Acute *Reduce pain and inflammatin *Prtect injured nerve *Imprve cervical withut radicular symptms *Manual therapy t increase jint mbility in the cervical and thracic spines *Gentle painfree cervical *Pain-free thracic prgressin Active cervical within a pain-free range Active thracic Scapular retractin exercises Lying ver a fam rller with head supprted If tlerated, deep neck flexr strengthening shuld be initiated * Avid any activity r exercise that reprduces radicular symptms. *Tractin *Pstural crrectin and retraining Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 5

6 Subacute *Reduce pain and inflammatin * Prtect injured nerve *Imprve cervical withut radicular symptms *Cntinue t prgress cervical * Cntinue t prgress thracic Cntinue active cervical within a pain-free range Cntinue active thracic Pectral stretches Scapular retractin exercises Lying ver a fam rller with head supprted If tlerated, deep neck flexr strengthening shuld be initiated * Avid any activity r exercise that reprduces radicular symptms. Rehab *Imprve thracic * Restre full pain free strength and t cervical and thracic spines *Functinal endurance training *Stretches t cervical musculature Prgressin f deep neck flexr strengthening Prgressin f neck extensr strengthening f periscapular muscles and thracic extensrs Cervical spine muscle stretches Glbal neck strengthening f periscapular muscles and thracic extensrs * Avid any activity r exercise that reprduces radicular symptms. Sprt Specific Gradual Return t Sprts and Physical Activity Maintain Full Passive/Active Cntinue as Needed Cntinue T-band and Periscapular Prgressins 3 x/ Week as Needed *Return t Sprts and Physical Activity per Surgen/Physical Therapist Evaluatin Dynamic Prgressins Cntinue Prpriceptive Drills During Return t Sprt 2-3 x/ Week *Achieve Full Pain Free and Excellent Strength Befre Prgressin Back t Sprt *Reviewed by Michael Geary, MD Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 6

7 References 1. Eubanks JD. Cervical radiculpathy: Nnperative management f neck pain and radicular symptms. American Family Physician. 2010; 81(1): Byles R, Ty P, Melln J, Hayes M, Hammer B. Effectiveness f manual physical therapy in treatment f cervical radiculpathy: a systematic review. Jurnal f Manual & Manipulative Therapy. 2011; 19(3): Cleland JA, Fritz JM, Whitman JM, Heath R. Predictrs f shrt-term utcme in peple with a clinical diagnsis f cervical radiculpathy. Phys Ther. 2007; 87(12): Suth Shre Hspital Orthpedic, Spine and Sprts Therapy in Clinical Cllabratin with Suth Shre Orthpedics Page 7