Neurological examination for cervical radiculopathy: a scoping review protocol
Authors: Yousif Marzia Stella , Occhipinti Giuseppe , Bianchini Filippo , Feller Daniel , Schmid Annina , Mourad Firas 
Published: May 2023

Introduction

Cervical radiculopathy (CR) is a common cause of pain in the neck and arm region, with a considerable impact on a person’s physical functioning, mental health, and social participation. The current knowledge of CR is mainly based on empirical concepts and early studies. Although action potential conduction slowing or block of a spinal nerve or its roots (i.e., loss of sensory and/or motor function) is a core sign of CR, among guidelines CR is still commonly defined by pain (i.e., gain of function) radiating into the arm. There is no consensus about the gold-standard for the diagnostic procedures for CR but it has been suggested that clinicians should assess CR by subjective and physical examination including a neurological examination, neural mechanosensitive testing and provocative manoeuvres. Among the several clinical tests routinely used to identify loss of function, the neurological examination historically played a role in the differential diagnosis and in the prognostic profile of radiculopathy. However, there is a paucity of studies investigating the diagnostic accuracy of the neurological examination for CR. Thus, the assessment of CR remains a clinical challenge among primary care clinicians. This often leads to an increased risk of misdiagnosis and inappropriate treatment, potentially contributing to delayed recovery and poor health outcomes. Therefore, according to the population, concept, context (PCC) strategy, our scoping review aims to investigate the evidence in regard to diagnostic accuracy (C) of the neurological examination for CR (P) and raise awareness among clinicians on how to appropriately perform this testing.

Methods and analysis

This scoping review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews checklist and the Joanna Briggs Institute (JBI) Reviewer’s Manual on scoping reviews. The aim of this scoping review is to explore what is already known about the neurological examination and its diagnostic value for CR.

Ethics and dissemination

This scoping review will not require ethical approval since it will synthesize information from publicly available studies. Results will be submitted for publication in a peer-reviewed journal, presented at relevant conferences in the field and disseminated through working groups, conferences, webinars, social media.

Strengths and limitations of this study

Our review will identify knowledge gaps to inform future research about the neurological examination for CR. Diagnostic values will be reported when available.

To the best of the authors’ knowledge, this is the first scoping review to provide a comprehensive overview on the neurological examination for CR.

The results will add meaningful information for clinicians to inform assessment of CR. It will also direct future research.

A robust clinical recommendation might be limited due to the lack of available literature