المتخصصون في المجالات الطبية

May 30, 2024

Radiculopathy is a relatively common condition that arises from injury or damage to the nerve root in the spine. Although it can occur within any segment of the spine, cervical and lumbar radiculopathy are more common than thoracic radiculopathy (TR).

Symptoms of TR can include any of the following, all of which can be exacerbated by movement: pain, paresthesia, allodynia or numbness affecting the abdomen, flank, chest, back or even breast.

Because TR is less common, physical medicine and rehabilitation (PM&R) physicians may be less familiar with the treatment options available for this specific diagnosis and how they differ from the treatments for cervical and lumbar radiculopathy. To address this knowledge gap, Mayo Clinic researchers conducted a systematic review analysis evaluating the impact of physical therapy (PT), without invasive procedures, to alleviate symptomatic TR. The results of the study were published in the Annals of Rehabilitation Medicine in 2024.

"We decided to focus our efforts on looking at physical therapy as a treatment," explains Cara C. Prideaux, M.D. Dr. Prideaux is a physiatrist at Mayo Clinic in Rochester, Minnesota, who served as the publication's corresponding author. "We know that physical therapy is known to have success in treating some cervical and lumbar radiculopathy cases, but less is known about the use of physical therapy for treating thoracic radiculopathy."

Study methods

The researchers conducted a database search for studies published from inception until January 27, 2023, that involved adult patients age18 and older who had an MRI-confirmed TR and underwent a structured, supervised PT program of any length. Among the 1,491 studies screened, seven studies met inclusion criteria, including five case studies and two cohort studies. The researchers also assessed study quality and risk of bias using the National Heart, Lung, and Blood Institute Study Quality of Assessment Tool, and certainty in evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Due to the lack of consistent, objective and well-described methods, measures and reported results within and between studies, the researchers did not perform a meta-analysis.

Results

• All studies showed improvement or resolution of TR with PT.
• Most studies did not note quantitative improvements and contained only sparse descriptions of the PT regimens.
• The evidence quality assessment categorized three studies as "good," one as "fair," and three as "poor." Certainty of evidence was described as "low" for all seven studies due to risk of bias.

"Overall, in completing this review, we learned that there is a lack of high-quality studies that have been performed looking at the efficacy of physical therapy in treating patients with symptomatic thoracic radiculopathy," explains Dr. Prideaux. "However, within the seven studies that met our criteria to be included, we found that a physical therapy program may help reduce symptoms related to thoracic radiculopathy. Thus, within clinical practice, if a patient is diagnosed with thoracic radiculopathy related to nerve compression confirmed on MRI, it would be reasonable to recommend physical therapy as a low-risk treatment before suggesting more-invasive treatments like injections or surgery."

Dr. Prideaux notes that more research is needed to establish the efficacy of physical therapy as a treatment for symptomatic thoracic radiculopathy. "Studies with better defined protocols for the physical therapy program would be helpful so that they can be easily reproduced and incorporated by others. Conducting randomized controlled trials would also strengthen the current literature in this area."

For more information

Mostert KA, et al. The efficacy of physical therapy to alleviate symptomatic thoracic radiculopathy: A systematic review and meta-narrative analysis. Annals of Rehabilitation Medicine. 2024;48:105.

Refer a patient to Mayo Clinic.