Physical tests for cervical radiculopathy

Value of physical tests in diagnosing cervical radiculopathy: A systematic review Thoomes, E., van Geest, S., van der Windt, D., Falla, D., Verhagen, A., Koes, B., Thoomes-de Graaf, M., Kuijper, B., Scholten-Peeters, W., & Vleggeert-Lankamp, C. Level of Evidence: 1a Follow recommendation: 👍 👍 👍 👍 Type of study: Diagnostic Topic: Cervical radiculopathy – Physical tests This is a systematic review assessing the usefulness of physical tests in making a diagnosis of cervical radiculopathy in patients with a disk herniation or osteoarthritic changes. Five papers, which compared physical test results against MRI/CT scans or surgical findings were included. The variables of interest were the sensitivity and specificity of physical tests. If a test is very sensitive and its result is negative, you can be more certain that the patient does not have the condition. If the test is specific and its result is positive, you can be more certain that the patient has the condition. Spurling’s test and cervical distraction test showed high specificity and low sensitivity. Upper limb neurodynamic tests showed high sensitivity and low specificity. The arm squeeze test showed high sensitivity and high specificity. The arm squeeze test is performed by compressing the anterior and posterior mid portion of the patient’s arm. The test is considered positive if compression of the arm is 3/10 points more painful than squeezing the patient’s shoulder joint. The cervical distraction test showed high specificity and low sensitivity. The cervical distraction test is considered positive when manual cervical traction relieves symptoms in the upper limb. Clinical Take Home Message: Hand therapists may use a combination upper limb neurodynamic test, and arm squeeze test to rule out a radiculopathy. If neurodynamic tests do not elicit pain and the arm squeeze test is negative, the presence of a radiculopathy is less likely. A diagnosis of cervical radiculopathy can be made if the arm squeeze test and Spurling’s test are positive, and if the cervical distraction test relieves pain. URL: https://www.thespinejournalonline.com/article/S1529-9430(17)30918-X/fulltext

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