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13 Apr 2019

Pinched Nerves in the Neck and TRACTION

 

Pinched nerves can cause lameness and offloading of a limb.  In people we call pain that runs down a limb, ‘a radiculopathy’.  Dogs would surely have the same… if they could talk!  However, offloading a limb and lameness might be doggy signs of a pinched nerve.

 

I had two cases come by this week that made me suspect pinched nerves or nerve root impingement.   The only trouble is that in both cases, neither of them have neck pain.   The first case, a Rhodesian Ridgeback is lame with a bit of a front foot stumble.  I was worried that he also had some triceps atrophy and given the lack of neck pain or any other finding that made sense, I put a differential diagnosis in the back of my brain for nerve sheath tumour.  So, since the owner is a vet, I told her this.  She then got a neuro consult, radiographs, and an MRI.  Nothing.  They found nothing.  So where does that leave us?  Well, I’m thinking it may be a chronic / intermittent pinched nerve.  Chronic in that the neck isn’t painful anymore.  (I keep trying to find a shoulder pathology… but I’m coming up empty as well.)  All I find is rib pain on ribs 1 & 2… so, could still be a pinched nerve.

 

The other case is a Rottweiler.  Twice within the last month the owner has called because the dog has been lame on a front leg.  The most recent time, the dog wouldn’t get out of the vehicle and refused to move.  She was also holding her leg out to the side a bit.  By the time she could get in to see me (about 2 days later), nothing!  Again, very minimal findings at all.  Again, this dog has had radiographs and bloodwork, showing nothing either.  But those symptoms sound an awful lot like a sudden pinched nerve with a subsequent front leg pain and non-use and lameness.

 

So, what’s the next plan?  Well, I just happened to come across this article, and it seems to make sense as my next plan of treatment…  and see what happens!

 

Romeo A, Vanti C, Boldrini V, et al.  Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy—A Systematic Review and Meta-Analysis of Randomized Controlled Trials.  Physical Therapy, Volume 98, Issue 4, 1 April 2018, Pages 231–242

 

Background: Cervical radiculopathy (CR) is a common cervical spine disorder. Cervical traction (CT) is a frequently recommended treatment for patients with CR.

Purpose: The purpose of this study was to conduct a review and meta-analysis of randomized controlled trials (RCTs) on the effect of CT combined with other physical therapy procedures versus physical therapy procedures alone on pain and disability.

Study Selection: All RCTs on symptomatic adults with CR, without any restriction regarding publication time or language, were considered.

Data Extraction: Two reviewers selected the studies, conducted the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. The evidence was assessed using GRADE criteria.

Data Synthesis: Five studies met the inclusion criteria. Mechanical traction had a significant effect on pain at short- and intermediate-terms and significant effects on disability at intermediate term. Manual traction had significant effects on pain at short- term.

Conclusions: In light of these results, the current literature lends some support to the use of the mechanical and manual traction for CR in addition to other physical therapy procedures for pain reduction, but yielding lesser effects on function/disability.

 

So… that’s my thought processing! We’ll see how it goes!

Good luck with all of your cases this week!

 

Cheers!   Laurie

 

Tags: pinched nerve , neck , traction , radiculopathy , lameness
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