A first year medical student using OMT as an adjunct treatment for managing an 80-year-old with cervical radiculopathy

Suwanee, GA

Introduction

Cervical radiculopathy is commonly attributed to degenerative spinal changes associated with aging. Conservative management with NSAIDS, muscle relaxers, opioids, and glucocorticoids can relieve symptoms, but have inherent risks particularly for patients >65 years-old or with comorbidities like diabetes mellitus. Alternatively, osteopathic manipulative treatment (OMT) is relatively low risk, even when performed by a supervised first-year DO student. One study highlights the overall effectiveness of OMT performed by first- and second-year DO students on family members outside a graded environment. Our case study demonstrates how adjunct OMT in an elderly patient with symptomatic cervical radiculopathy and diabetes mellitus provides symptomatic relief and reduced medication use.

Case Study

An 80-year-old woman with controlled diabetes mellitus presents with progressive neck pain and right arm weakness over 5 months. Pain is 8/10, affecting sleep and daily activities. Vitals are normal. She has restricted neck movement and positive Spurling’s test. Bloodwork includes hemoglobin A1c of 7.2 and normal kidney function. X-rays reveal degenerative changes and severe stenosis at C5-6. She receives an intramuscular depomedrol injection and prescriptions for diclofenac BID and cyclobenzaprine BID PRN. She begins weekly 30-minute OMT sessions for 7 weeks by a supervised first-year DO student, and biweekly physical therapy (PT) from weeks 2-4. By Week 7, she weaned off cyclobenzaprine and her pain stabilized to 3/10 on diclofenac alone and 2/10 after OMT. She also reports reduced nocturnal arm pain, improved mobility with activities of daily living.

Discussion/Conclusion

After 7 weeks of combined treatment with medication, PT, and OMT, our patient reported an overall improvement of symptoms. Utilization of PT and OMT was integral in our patient’s management plan in effort to provide symptom relief with minimal use of medications, in which she was successfully weaned off cyclobenzaprine. Several studies support the benefits of OMT for low back pain, including improvement of pain and function, as well as reducing the use of opioids and interventional therapies, prolonged PT, and diagnostic tests. While fewer studies exist assessing OMT in chronic neck pain, the data overall supports its usefulness in improving neck pain symptoms. With over 100 OMT techniques to choose from, the safety and effectiveness largely depends on the DO’s comfortability of the technique; with the exception of HVLA which should be avoided in the elderly or patients with osteoporosis. In the rare cases where injury was related to manipulative techniques, these incidences more commonly occurred due to lack of experience by the provider, such as a non-DO manipulator or unsupervised DO student, especially in the neck area. Appropriate caution must be exercised with novice performance of OMT on patients, especially in the elderly, but most evidence undeniably supports the medical utility of adjunct OMT. A survey reveals <5% of DOs incorporate the use of OMT in their regular practice, therefore the authors implore the encouraged use of OMT in current DO students to help eventually resolve the underutilization of the valuable tool that is OMT.