A 35-year-old office worker presents with neck pain radiating into the right arm for the past three weeks. He reports tingling in the thumb and index finger, weakness while gripping objects, and increased symptoms with prolonged computer use.

This presentation suggests cervical radiculopathy.

Understanding Cervical Radiculopathy

Cervical radiculopathy occurs when a cervical nerve root is compressed or irritated. Common causes include:

• Disc herniation
• Degenerative changes
• Foraminal narrowing
• Cervical spondylosis

Symptoms often follow a dermatomal pattern.

Step 1: Subjective Assessment

Important questions:

• Onset and duration of symptoms
• Nature of pain (sharp, burning, radiating)
• Aggravating positions
• History of trauma
• Red flags (weight loss, severe neurological deficit)

Radicular pain typically worsens with neck extension or prolonged sitting.

Step 2: Objective Examination

Observation

• Postural deviations (forward head posture)
• Guarded neck movement

Range of Motion

Assess flexion, extension, rotation, and lateral flexion.

Pain reproduction during extension-rotation may indicate nerve compression.

Neurological Examination

• Dermatomal sensation testing
• Myotomal strength testing
• Reflex assessment

Weakness or altered sensation confirms nerve involvement.

Special Tests

• Spurling’s test
• Cervical distraction test
• Upper limb tension test

These help confirm radicular symptoms.

Differential Diagnosis

Differentiate from:

• Shoulder pathology
• Peripheral nerve entrapment
• Myofascial pain
• Thoracic outlet syndrome

Accurate diagnosis guides treatment.

Rehabilitation Plan

Phase 1: Pain Reduction

Goals:

• Reduce nerve irritation
• Improve posture
• Relieve symptoms

Interventions:

• Cervical traction (if appropriate)
• Gentle mobility exercises
• Postural correction
• Activity modification

Phase 2: Mobility and Neural Control

Goals:

• Restore cervical range
• Improve neural mobility

Interventions:

• Neural gliding exercises
• Cervical mobility drills
• Scapular stabilization exercises

Phase 3: Strengthening and Functional Training

Goals:

• Improve deep neck flexor strength
• Enhance upper back stability
• Prevent recurrence

Interventions:

• Deep cervical flexor training
• Scapular retraction exercises
• Ergonomic advice

Patient Education

Educate on:

• Proper workstation setup
• Avoiding prolonged neck flexion
• Taking movement breaks

Lifestyle modification is essential.

When to Refer?

Referral is necessary if:

• Progressive neurological weakness
• Severe unrelenting pain
• Signs of spinal cord involvement

Clinical Reasoning Summary

Cervical radiculopathy requires:

• Thorough neurological assessment
• Postural evaluation
• Stage-based rehabilitation
• Monitoring symptom response

Avoid aggressive techniques during acute irritation.

Conclusion

Physiotherapy cervical radiculopathy management focuses on reducing nerve compression, restoring mobility, and strengthening supportive structures. With structured rehabilitation and ergonomic modification, most patients achieve significant improvement.

Early intervention prevents chronic nerve irritation and long-term disability.