Neurological examination for cervical radiculopathy: a scoping review.

Abstract

Background: To diagnose cervical radiculopathy according to the International Association for the Study of Pain definition, signs of neurological deficits must be examined with the neurological examination. However, the diagnostic accuracy of the standard neurological examination remains unclear, and no clear recommendations exist about standard components. Therefore, the objectives of this review are to map the research about the diagnostic accuracy, components, and performance of the neurological examination for cervical radiculopathy.

Method: PubMed, Embase, Scopus, Cinhal, DiTA databases were searched up to February 23rd, 2024. Additional studies were identified through screening reference lists of the included studies. Studies on neurological examination procedures and their diagnostic accuracy for cervical radiculopathy were included.

Results: From an initial 12,365 records, 6 articles met the inclusion criteria. All articles were cross-sectional studies and compared the neurological examination with electrodiagnostic tests or magnetic resonance imaging. Reduced tendon reflexes were found to be most specific (81% (95% CI 69-89%) to 99% (95% CI not reported)), while somatosensation testing was least sensitive (25% (95% CI 12-38%; -LR 0.84) to 52% (95% CI 30-74%)). Taking all components into account resulted in higher specificity (98% (95% CI not reported) to 99% (95% CI 95-100%)) but lower sensitivity (7% (95% CI not reported) to 14% (95% CI 5-16%)) compared to electrodiagnostic tests.

Conclusions: We found varying operational definitions of radiculopathy, suboptimal reference standards, and great heterogeneity in the neurological examination procedure and its diagnostic accuracy. Future research should address these issues to establish the clinical utility of the neurological examination for cervical radiculopathy.

Protocol: https://doi.org/10.1101/2023.05.22.23290194 .