1. Resolution of Cervical Radiculopathy in a 61 Year Old Female
Receiving Subluxation Based Chiropractic Care: A Case Report
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Introduction
Cervical radiculopathy is a complaint prevalent in patients
aged 40-60 years.1
It has an annual incidence of 85 per
100,000 and is more common in men than women with a peak
incidence in the sixth decade of life.2
Diagnosis of cervical
radiculopathy is largely based on standard clinical history and
examination findings with radiographs. An MRI can be used
for confirmation.1
A common etiology in those over 60 years is degenerative
changes in the cervical spine. The intervertebral foramen and
disc can decrease in size and put pressure on the nerve roots
that branch from the intervertebral foramen to the arms and
hands.3
Patients present with numbness in their hands and
arms with or without neck pain and clinical assessment can
reveal some or all of the following: reduction in dermatomal
sensation, reduction in deep tendon reflexes and myotomal
weakness for the involved nerve root.
Conventional treatment commonly involves non-steroidal anti-
inflammatory drugs (NSAIDs) and surgery. However, in older
patients recovery from surgery takes longer and there are often
worse surgical outcomes and longer hospital stays.4
Alternatively, conservative therapy can include chiropractic
care, cervical traction, cranio-sacral therapy, soft tissue
therapy and physiotherapy. In 2008 Whalen reported that 80-
90% of radiculopathy resolves with conservative care.1
It has
been shown that a multimodal approach for geriatric patients
with cervical radiculopathy is effective in reducing pain and
increasing spinal function and motion.2
Roffers et al reported
improvement in a young woman with traumatic
Abstract
Objective: To describe a case in which cervical radiculopathy in a geriatric
patient improved while they were receiving chiropractic care.
Clinical Features: This case report outlines the presentation and conservative
management of a 61 year old New Zealand Samoan female with chronic
progressive symptomatic radiculopathy. The working diagnosis was vertebral
subluxation with C5 and C6 radiculopathy with moderate to severe
degeneration. The patient history revealed chronic progressive cervical
radiculopathy for two months prior to commencing chiropractic care. The
patient had numbness and a burning sensation in the right arm and stiffness in
the lower cervical spine.
Interventions and outcomes: The patient received chiropractic care using
the Diversified protocol to adjust vertebral subluxations. After 11 visits the
patient reported a significant improvement in numbness and tingling in her
arm and improvement in quality of life as demonstrated by the RAND 36
health survey.
Conclusions: In this case cervical radiculopathy in a geriatric patient
improved while she received chiropractic care. This case study adds to the
existing body of evidence that suggests that chiropractic care may help
patients with cervical radiculopathy.
Key words: Vertebral subluxation, paresthesia, chiropractic, cervical
radiculopathy, conservative therapy, geriatric
Adele L. Lorigan1
Shelley Smith1
Helen Bennett2 MLIS, BA, NZLA
Cert
1. Senior Intern, New Zealand
College of Chiropractic
2. Librarian and Lecturer, New
Zealand College of
Chiropractic
Case Study
A. Vertebral Subluxation Res. September 9, 2015 154Cervical radiculopathy

2. cervical radiculopathy following chiropractic care.4
Other
studies have also shown improvement associated with
chiropractic care in cervical radiculopathy caused by cervical
disc herniations.2
The purpose of this case study is to add to
the growing body of evidence that supports chiropractic as a
care option for geriatric patients suffering from radiculopathy.
Case Report
History
A 61 year old New Zealand Samoan female presented for
chiropractic care. She worked 40 hours per week as an
administrative assistant, seated at a desk. She had mild
hypertension rated bilaterally at 140/90 and was not taking any
medication at the time of presentation.
The patient reported a two month history of numbness,
tingling and a burning sensation in her right arm affecting her
lateral arm at the deltoid tuberosity and right thenar eminence.
She reported experiencing pain from the lateral forearm to
dorsal hand, thumb and index finger. The pain was felt up to
12 times per day and lasted for a few minutes and was rated as
4-5/10 on a visual analogue pain scale and was progressing.
The patient reported that stretching of the cervical spine
muscles was not helpful.
The patient also complained of stiffness in her posterior neck,
primarily on the right side of the C7/T1 spinous processes.
This had started insidiously twenty years earlier. She first
noticed this with restricted range of motion in the neck, rating
it at a 1/10 on a visual analogue pain scale. The patient had
not sought any previous care for her presenting condition.
Examination
Chiropractic, neurological and cardiovascular examinations
were performed. Blood pressure was 140/90 bilaterally and
the patient reported that this had been high for 12 months and
her general practitioner had advised her to lose weight. Her
body mass index (BMI) was recorded as 30.8 which is
considered to be obese.6
Neurological screening including myotome, dermatome, and
reflex tests of the upper and lower extremities were
performed. The biceps deep tendon reflex was reduced (+1)
on the right. Range of motion of the cervical spine was
reduced for lateral flexion and rotation bilaterally. Postural
assessment revealed anterior head carriage, loss of the cervical
lordosis, and elevation of the left shoulder. Vertebral
subluxation findings at C2, T1, T8, right ilium, C1, C7, T9,
T12 were noted upon spinal examination.
The working diagnosis was “C5/C6 cervical nerve root
impingement and vertebral subluxation complex.” C5
radiculopathy presents with deltoid and bicep muscle
weakness and a reduction in the C5 bicep tendon reflex. C6
radiculopathy presents with sensory changes in the lateral
forearm to the dorsal surface of the hand, thumb and index
finger and the brachioradialis reflex can be depressed.6
The
muscles affected are bicep brachii, extensor carpi radialis
longus and brevis.
Intervention
The patient presented twice a week for 6 weeks and was
adjusted using the Diversified technique with a progress report
on the 12th
visit.
At the progress visit the patient reported greater ease with
movement and reduction in numbness at the right C5 and C6
dermatome. She also mentioned an improvement in posture,
an increase in flexibility, walking, standing, lying, sleeping,
reduced stress, an increase in alertness and state of mind.
RAND36 Health Survey scores showed an improvement in
general health from 80 to 85 and physical function from 80 to
100. Her bicep tendon reflex returned to normal at 2+. There
was an increase in cervical rotation and visual analogue scores
improved from 4-5/10 to a 0-1/10 pain. After 2 months of
chiropractic care the sensory changes in the lateral forearm to
the dorsal hand had completely resolved.
Discussion
The resolution of cervical radiculopathy in this case study
contributes to the small body of evidence that suggests that
older patients with degenerative conditions may benefit from
receiving chiropractic care. There are many theories that may
explain why chiropractic care may help patients suffering
from nervous system dysfunction. Haavik et al proposed that
vertebral subluxations may lead to altered sensorimotor
integration and that the correction of the vertebral subluxation
can result in improved functioning of the central nervous
system.7
The correction of the vertebral subluxation can improve
radiculopathy and pain sensation, assist with balance, daily
activities and movement in older patients.8
Studies show that
after periods of prolonged sitting, longer healing time occurs
and disc dehydration can lead to the incidence of disc
degeneration disease.9,10
This is important especially as the
population is ageing and there is increasing interest in
alternative, conservative therapy. In New Zealand those over
the age of 65 will double over the next 20 years to around 1.2
million in 2036.11
It should be acknowledged that there are inherent limitations
associated with the case study design such as the potential for
natural progression and confounding variables being present
that are associated with the uncontrolled nature of case
studies. Little is known about the natural progression or
duration of cervical radiculopathy. More research is vital to
add to the limited body of knowledge concerning the
relationship between chiropractic care and improvements in
cervical radiculopathy.7,12
Conclusion
This case reports a reduction in cervical radiculopathy in a
geriatric patient receiving chiropractic care. It adds to the
growing body of evidence that chiropractic care may be
beneficial for some older patients suffering from degenerative
conditions. More research is required to better understand the
role chiropractors may play in caring for this patient
population.
155 A. Vertebral Subluxation Res. September 9, 2015 Cervical radiculopathy

3. References
1. Whalen WM. 2008. Resolution of cervical
radiculopathy in a woman after chiropractic
manipulation. Journal Chiropractic Medicine, vol 7,
no 1, pp17-23.
2. Dufton JA, Giantomoaso T. 2003. The chiropractic
management of two cases of cervical spondylotic
radiculopathy. Journal of Canadian Chiropractic
Association, vol 47, no 2, pp. 121-126.
3. Forbush SW, Cox T, Wilson E. 2011. Treatment of
patients with degenerative cervical radiculopathy
using a multimodal conservative approach in a
geriatric population: a case series. Journal
Orthopedic Sports Physical Therapy, vol 41, no 10,
pp. 723-733.
4. Stawicki S, 2009. Cervical Disc Disease in geriatric
patients: A Comparison Study. European Journal of
General Medicine, pp 140-14.
5. Roffers SD., Hoiriis KT., Duffy JL., 2010.
Resolution of Traumatic Cervical Radiculopathy with
Chiropractic Care to Reduce Vertebral Subluxations:
A Case Report. Journal Vertebral Subluxation Res.
6. National Heart, Lung and Blood Institute. 2014.
Accessed on 19/9/2014
<https://nihlbi.nih.gov/health/educational/lose_wt/B
MI/bmi-m.htm>
7. Haavik- Taylor H., Holt K., Murphy B. 2012.
Exploring the Neuromodulatory Effects of the
Vertebral Subluxation and Chiropractic Care.
Chiropractic Journal of Australia,vol 40, no 1, pp.
37-44.
8. Holt KR, Noone PL, Short K, Elley CR, Haavik H.
2011. Fall risk profile and quality of life status of
older chiropractic patients. Journal of Manipulative
and Physiological Therapeutics, vol 34, no 2, pp. 78-
87.
9. Bogduk, N. 2005. Clinical Anatomy of the Lumbar
Spine and Sacrum, 4th
Edition. Elsevier Ltd,
Philadelphia, USA.
10. Khong P., Bogduk, N. 2013. Cervical disc
arthroplasty for the treatment of spondylotic
myelopathy and radiculopathy. Journal of Clinical
Neuroscience, DOI: 10.1016.
11. Ministry of Social Development. New Zealand, 2014.
Accessed on 12/9/2014. <http//mds.govt.nz>
12. Nowinski J., Swate G., Hunnisett A., Cunliffe C.
2013 Chiropractic treatment in the elderly population.
Journal of Chiropractic Medicine, vol 12, Number 2,
June, pp131.
A. Vertebral Subluxation Res. September 9, 2015 156Cervical radiculopathy