Rotary manipulation for cervical radiculopathy: observations on the importance of the direction of the thrust.

OBJECTIVE: To describe the clinical presentation of eight patients with cervical spine radiculopathy, the manipulation technique used for each patient and the outcomes of treatment. CLINICAL FEATURES: The cause of radiculopathy in four patients was disc herniation. The other four patients had a combination of spondylosis, disc herniation and sprain injury. INTERVENTION AND OUTCOME: Six of eight patients had a good outcome associated with receiving manipulation performed by contacting the cervical spine at the level of the radiculopathy, laterally flexing toward the side of radiculopathy, rotating the neck away from the side of the radiculopathy and applying a gentle high-velocity, low-amplitude thrust. Two patients had an exacerbation of arm pain and increased neurological deficit associated with manipulation performed with the neck rotated toward the side of radiculopathy. CONCLUSION: There is little compelling evidence supporting or disputing the use of manipulation for patients with cervical spine radiculopathy. In our patients, rotary manipulation was associated with a different outcome depending on the direction of neck rotation. Prospective time-series studies and randomized, blind trials are needed to identify the efficacy and effectiveness of different manipulation techniques for this condition.

Interexaminer reliability of palpation for cervical spine tenderness.

OBJECTIVE: To assess the interexaminer reliability of manual palpation for cervical spine tenderness in neck pain patients. DESIGN: Interexaminer reliability was studied using a within-subjects (repeated measures) design. Seven joints on the symptomatic side of the neck were palpated for maximal tenderness. SETTING: Private chiropractic practice of the Los Angeles College of Chiropractic. PATIENTS: Thirty patients with unilateral mechanical neck pain, symptomatic at the time of examination, were recruited from a chiropractic practice. RESULTS: Good interexaminer reliability (kappa = .68, p < .001, percent agreement 76.6%). CONCLUSION: In this population, palpation for cervical spine tenderness is a highly reliable examination tool. The findings of this study are consistent with those of palpation of the lumbar spine. Further investigation is needed to assess the usefulness of spinal tenderness as an outcome measure, the behavior of tenderness over time, and the prevalence of tenderness in symptomatic and asymptomatic populations.