Tingling, Weakness & Pain? Let’s Talk Cervical Radiculopathy with Dr. Erik Thoomes

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Mar 5, 2025

Dr. Erik Thoomes, a musculoskeletal clinician and educator, dives deep into cervical radiculopathy, distinguishing it from typical neck pain. He highlights causes like nerve root irritation and discusses effective diagnostic techniques. The conversation emphasizes tailored treatment strategies and challenges conventional approaches, advocating for personalized assessments and innovative therapies like neurodynamic mobilization. With a focus on patient education, Dr. Thoomes underscores the role of self-management and the need for ongoing research in this critical area.

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INSIGHT

Understanding Cervical Radiculopathy

Cervical radiculopathy is a specific neck pain caused by cervical nerve root irritation or compression.
It typically involves arm and shoulder pain, unlike non-specific neck pain which lacks nerve root involvement.

INSIGHT

Cervical vs Lumbar Spine Differences

Cervical and lumbar spine differ significantly in anatomy and function.
Cervical spine allows more rotation and requires different clinical consideration compared to lumbar spine.

ADVICE

Diagnostic Approach to Cervical Radiculopathy

Use comprehensive patient history as the first step in diagnosing cervical radiculopathy.
Combine Spurling's test, upper limb neural tension tests, and neurological exams to improve diagnostic accuracy.

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In Episode 74 of the Physiotutors podcast, host Kai is joined by Dr. Erik Thoomes, an expert in musculoskeletal conditions, particularly cervical radiculopathy. Dr. Thoomes provides an in-depth discussion on cervical radiculopathy, distinguishing it from nonspecific neck pain. He explains that cervical radiculopathy involves radiating arm pain due to nerve root irritation or compression, often caused by disc herniation or spondylotic changes, contrasting it with lumbar radiculopathy.

The episode emphasizes the importance of thorough patient history in diagnosis and suggests a cluster of tests including Spurling's test and neural tension tests to improve diagnostic accuracy. Dr. Thoomes also challenges the reliability of traditional dermatomes and myotomes, advocating for individualized assessment and treatment strategies.

The conversation covers various treatment options, highlighting the ineffectiveness of cervical traction and suggesting neurodynamic mobilization, spinal manipulative therapy, and targeted exercises. Dr. Thoomes advises adapting management strategies from acute to chronic stages and stresses the role of patient education and self-management. The episode also touches on the limited role of imaging unless necessary and discusses the importance of differentiating cervical radiculopathy from other conditions.

Dr. Thoomes calls for more research in areas like epidemiological data and neurodynamic mobilization and shares clinical gems for effective management. The episode concludes with an emphasis on individualized patient care and encourages questions and further discussion from listeners.

Content

00:00 Intro 00:52What is Cervical Radiculopathy? 04:05 Cervical vs Lumbar Disc Herniation 05:29 Clearer Terminology needed 07:15 Prevalence and Risk Factors 08:26 Most useful Tests 10:33 Crucial History Findings 11:56 Dermatomal/myotomal examination 13:13 Treatment Options 18:27 Manipulations? Mobilizations? 21:29 Motor Control Training 24:55 Directional Preference in the Cervical Spine? 26:03 Higher Level Exercises 27:01 Self-Management 28:52 Diagnostic Mistakes to Avoid 31:30 Red Flags and Imaging 33:15 Lessons to learn from LRS 34:25 Future Research Directions 37:45 Top Tips 39:27 Outro & Contact Info

Bonus Material

Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App.

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