Cervical Radiculopathy

Distribution of pain (unilateral/bilateral)


Severity of pain


Character of pain (e.g., sharp, stabbing, burning)


Aggravating factors (e.g., movement, coughing, sneezing)


Alleviating factors (e.g., rest, specific positions, medications)


Previous Next

Reports Tingling or numbness in upper extremities Muscle weakness in the arms Reduced grip strength Reduced fine motor skills

Reports No Tingling or numbness in upper extremities No Muscle weakness in the arms No Reduced grip strength No Reduced fine motor skills

Report negative symptoms?

Previous Next

Red Flag Symptoms

Reports Progressive worsening Loss of coordination Loss of balance Loss of bowel control Loss of bladder control Severe, unremitting pain Pain at night Fever Unexplained weight loss History of cancer

Reports No Progressive worsening No Loss of coordination No Loss of balance No Loss of bowel control No Loss of bladder control No Severe, unremitting pain No Pain at night No Fever No Unexplained weight loss No History of cancer

Report negative symptoms?

Previous Next

Has a history of Previous neck trauma or injury Previous spinal surgery Diabetes Smoking Family history of cervical radiculopathy Occupation involving repetitive neck movements or vibration exposure

Has no history of Previous neck trauma or injury Previous spinal surgery Diabetes Smoking No Family history of cervical radiculopathy No Occupation involving repetitive neck movements or vibration exposure

Report negative symptoms?

Previous Next

Details of any conservative treatments tried (e.g., physiotherapy, chiropractic care, acupuncture)


Response to conservative treatments


Previous medications used for pain management and their effectiveness


Use of cervical collars or braces and their impact


Previous Next

Details of any imaging studies (X-ray, MRI, CT scan) and their findings


Details of any nerve conduction studies or electromyography (EMG) and their findings


Previous Next

Plans for future management


Interest in/eligibility for surgical intervention


Concerns about long-term disability or prognosis


Psychosocial factors impacting condition or treatment compliance


Previous Next

Any other relevant details



Previous Create Clerk Sheet Email Clerk Sheet Copy Clerk Sheet