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

Background

Cervical spondylosis with radiculopathy is a common cause of neck pain with referredupper-limb symptoms in middle-aged adults. Conservative physiotherapy is the recommended first-linemanagement strategy. Accurate clinical differentiation of cervical radiculopathy from peripheralentrapment neuropathies, shoulder pathology, and vascular causes requires systematic neurodynamictesting, segmental provocation assessment, and appropriate imaging.Case Presentation: A 45-year-old male office worker presented with a one-week history of right-sidedneck pain radiating along the radial nerve distribution to the wrist. Clinical examination revealed apositive upper-limb neurodynamic test (ULNT2b), an extension-provoked and flexion-relieved painpattern, preserved and equal radial pulses bilaterally, brisk deep tendon reflexes without upper motorneuron signs, and a positive cervical compression test. Plain cervical radiographs demonstrated loss ofcervical lordosis with multilevel spondylotic osteophytes; right shoulder radiographs were within normallimits.Intervention: A three-phase conservative physiotherapy programme was implemented, guided byclinical 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) advancedto Mulligan mobilisation-with-movement, cervical isometrics, and progressive rotator cuff and scapularstrengthening. Phase 3 (Month 1 onward) introduced progressive resistance training and McKenzie-based directional exercises. Repeat cervical radiography at seven weeks confirmed radiographic stabilitywithout new structural findings.Outcome: At one-month follow-up, pain intensity on the Numeric Pain Rating Scale (NPRS) reducedfrom 8/10 to 3/10 (62.5% relative reduction, exceeding the established minimal clinically importantdifference [MCID]). Neck Disability Index (NDI) scores improved from 25/50 (moderate disability) atbaseline to 7/50 (minimal disability) at one-month follow-up, surpassing the published MCID. Activecervical range of motion improved substantially across all planes: extension from 27° to 35°, flexionfrom 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 conservativephysiotherapy approach to cervical radiculopathy with radial nerve mechanosensitivity. Clinicallymeaningful improvements in pain, disability, and cervical mobility were achieved within one month,supporting the role of individualised staged conservative management in this patient population. Thiscase report was prepared following the CARE (CAse REport) guidelines.