The role of altered neurodynamics in patients with cervical radiculopathy

Thoomes, Erik ORCID: 0000-0001-6375-2267 (2024). The role of altered neurodynamics in patients with cervical radiculopathy. University of Birmingham. Ph.D.

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Abstract

Cervical radiculopathy (CR) is a clinical condition associated with symptoms of neck, shoulder, and upper limb pain as well as upper limb paraesthesia and weakness, which are attributed to cervical nerve root irritation. There is a paucity of evidence on the diagnosis and management of patients with CR. This thesis investigated (1) the validity of neurodynamic and other physical tests in diagnosing patients with CR, (2) the effect of neurodynamic mobilisation on longitudinal nerve movement in patients with CR compared to healthy matched controls, (3) the effectiveness of neurodynamic mobilisation in patients with CR and (4) the optimal timing of neurodynamic mobilisation and other conservative treatment modalities for patients with CR considering the evolution of the disorder.
A systematic review of the literature concluded that, when consistent with the patient’s history and other physical findings, a combination of a positive Spurling’s test and at least one positive upper limb neural tension test (ULNT) in a cluster of all four ULNTs may be used to increase the likelihood of the presence of CR.
A case-controlled study concluded that longitudinal median nerve movement at the wrist and the elbow is significantly less in patients with CR compared to healthy matched volunteers. But after 3 months of multi-modal conservative management, this difference is no longer present. Monitoring of the improvement in median nerve movement using ultrasound imaging has the potential to assist clinical decision making with regards to either continuing or suspending conservative management. This study also reported that an increase in nerve movement is strongly correlated with improvement in functional disability assessed by the Patient Specific Functional Scale, Neck Disability Index and Global Perceived Effect.
A systematic review of the literature concluded that there is low to very low-level evidence that neurodynamic mobilisation is effective on pain, disability and physical function in patients with CR.
Finally, an E-Delphi study was conducted which concluded that some of the previously reported generally effective conservative treatment modalities are more clinically useful than others across the different stages of CR.
The overall conclusions of the research presented in this thesis is that neurodynamics play an important role in both the diagnosis and conservative management of CR.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):