Clinical Prediction Rules: Cervical Spine

Your patient walks into your clinic with neck pain that radiates into their arm…now what? How do you know what it is, what you should do, and if they are going to respond well to conservative therapy? With the help of several research studies we thankfully have the answer to some of these questions.

Wainner et al published a study investigating the reliability and accuracy of different examination procedures for cervical radiculopathy. In the study he found four key features to help rule in the diagnosis of a cervical radiculopathy, with a positive likelihood ratio of over 30 if patients were positive on the rule. These four findings were the following:

  • Positive Upper Limb Tension Test A
  • Positive Spurling A Test
  • Positive Cervical Distraction Test
  • Cervical Rotation <60 degrees (to the involved side)

By using the above clinical prediction rule, you can provide a more accurate diagnosis for your patient, as well as better direct your interventions at addressing the underlying cause of the patient’s symptoms.

Now that we know what it is, how do we fix it? Today we are going to focus on one specific intervention technique; cervical traction. In 2009, Raney et al developed a clinical prediction rule to determine whether or not a patient was more likely to benefit from traction as an intervention:

  • >55 years of age
  • Peripheralization of symptoms with C4-C7 mobility testing
  • Positive Cervical Distraction Test
  • Positive Upper Limb Tension Test A
  • Positive Shoulder Abduction Test

If your patient has 4 out of 5 of the above predictors there is nearly a 95% likelihood that they would benefit from cervical traction as an intervention technique.

Finally, is there any way to know whether or not your patient will short-term success with therapy? Cleland et al found that there were four factors that indicated that the patient will have a positive outcome within 28 days:

  • <54 years old
  • Dominant arm not affected
  • Looking down does not increase symptoms
  • Multimodal treatment approach including manual therapy, cervical traction, and deep neck flexor muscle strengthening for at least 50% of visits

When all four variables were present, Cleland found the probability of success was nearly 90%. Not a bad statistic to provide your patient with to motivate them to come to physical therapy.

By using the articles and research above, you can provide better quality care for your patients that complain of neck and arm pain. Stay tuned for more posts about how we can get these patients better faster!