CONSERVATIVE PHYSIOTHERAPY MANAGEMENT OF CERVICAL SPONDYLOTIC RADICULOPATHY WITH RADIAL NERVE TENSION SIGNS: A CASE REPORT

Abstract

Background: Cervical spondylosis with radiculopathy is a common cause of neck pain with referred
upper-limb symptoms in middle-aged adults. Conservative physiotherapy is the recommended first-line
management strategy. Accurate clinical differentiation of cervical radiculopathy from peripheral
entrapment neuropathies, shoulder pathology, and vascular causes requires systematic neurodynamic
testing, segmental provocation assessment, and appropriate imaging.
Case Presentation: A 45-year-old male office worker presented with a one-week history of right-sided
neck pain radiating along the radial nerve distribution to the wrist. Clinical examination revealed a
positive upper-limb neurodynamic test (ULNT2b), an extension-provoked and flexion-relieved pain
pattern, preserved and equal radial pulses bilaterally, brisk deep tendon reflexes without upper motor
neuron signs, and a positive cervical compression test. Plain cervical radiographs demonstrated loss of
cervical lordosis with multilevel spondylotic osteophytes; right shoulder radiographs were within normal
limits.
Intervention: A three-phase conservative physiotherapy programme was implemented, guided by
clinical irritability assessment at each stage. Phase 1 (Days 1–5) comprised electrophysical agents
(therapeutic ultrasound, conventional TENS), thermal application, postural and ergonomic education,
cervical offloading strategies, and introductory neuromuscular exercises. Phase 2 (Days 6–30) advanced
to Mulligan mobilisation-with-movement, cervical isometrics, and progressive rotator cuff and scapular
strengthening. Phase 3 (Month 1 onward) introduced progressive resistance training and McKenzie-
based directional exercises. Repeat cervical radiography at seven weeks confirmed radiographic stability
without new structural findings.
Outcome: At one-month follow-up, pain intensity on the Numeric Pain Rating Scale (NPRS) reduced
from 8/10 to 3/10 (62.5% relative reduction, exceeding the established minimal clinically important
difference [MCID]). Neck Disability Index (NDI) scores improved from 25/50 (moderate disability) at
baseline to 7/50 (minimal disability) at one-month follow-up, surpassing the published MCID. Active
cervical range of motion improved substantially across all planes: extension from 27° to 35°, flexion
from 45° to 61°, right rotation from 45° to 63°, left rotation from 50° to 65°, left lateral flexion from 30°
to 42°, and right lateral flexion from 36° to 47°.
Conclusion: This case illustrates a structured, irritability-guided, phase-based conservative
physiotherapy approach to cervical radiculopathy with radial nerve mechanosensitivity. Clinically
meaningful improvements in pain, disability, and cervical mobility were achieved within one month,
supporting the role of individualised staged conservative management in this patient population. This
case report was prepared following the CARE (CAse REport) guidelines.