Physical Therapy Management Involving a Direct Access Patient with Cervical Radiculopathy Electing Surgical Intervention: A Case Report and Literature Review

Background: Cervical radiculopathy is a prevalent neck pathology characterized by its impact on strength, sensation, and overall function. As the occurrence of direct access in physical therapy continues to grow, so does the importance of proper referral and patient management. The purpose of this report is to provide and evaluate the factors that guide the treatment and referral of individuals with cervical radiculopathy. Case Study: A 28-year-old male presented as direct access to physical therapy with symptoms suggestive of acute cervical radiculopathy. His examination revealed strength, sensation, and reflex deficits correlating to a C6/7 cervical level. Following five weeks of conservative treatment, consisting of strengthening, manual therapy, traction and education, as well as referral to a physician, the patient elected to pursue surgical intervention of an artificial disc replacement (ADR). Outcome Measures: Primary measures used to assess the patient’s progress included the Neck Disability Index, cervical range of motion, dynamometry, the Patient Specific Functional Scale (PSFS), and the Global Rating of Change scale (GRoC). The post-surgical outcomes of the patient discussed in this case are unavailable, as the patient did not return to physical therapy. Discussion: Direct access in physical therapy highlights the importance that the physical therapist understands the appropriate timeline and indicators for referring an individual with cervical radiculopathy to another provider. In the long term, the literature suggests that both conservative and surgical interventions provide similar results after one year. This case highlights the various conservative and surgical interventions, and the importance of appropriate referral in order to optimize patient care.