Mechanical Traction for Neck Pain

Clinical Prediction Rule

  • Peripheralization with lower cervical spine (C4-7) mobility testing
  • Positive shoulder abduction test
  • Age ≥ 55 years-old
  • Positive upper limb tension test A
  • Positive neck distraction test
0+
Variables Present

Positive Likelihood Ratio =

Probability of Success
79.2%
0+
Variables Present

Positive Likelihood Ratio =

Probability of Success
94.8%

Shoulder Abduction Test

Diagnostic Accuracy when used alone:
Sensitivity
17-78%

Specificity
75-92%

Reference: Rubinstein et al.

Neck Distraction Test

Diagnostic Accuracy when used alone:

Sensitivity
44%

Specificity
90-97%

Reference: Rubinstein et al.

Upper Limb Tension Test A (Median Nerve Bias)

Diagnostic Accuracy when used alone:

Sensitivity
72-97%

Specificity
11-33%

Reference: Rubinstein et al.

Evidence

Raney NH et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009 Mar;18(3):382-91. Epub 2009 Jan 14.

“This preliminary [clinical prediction rule] provides the ability to a priori identify the sub-group of patients with neck pain likely to benefit from cervical traction and exercise, which has the potential to improve decision-making in clinical practice. The results of this study represent the initial step in the development of a prediction rule. Future studies are needed to validate the rule and determine its impact on clinical practice patterns, patient outcomes, and costs.”Raney NH et al.
Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Feb;44(2):45-57.

“It is important to note that the patients in our study were required to have distal symptoms to be enrolled, thus it is possible that the magnitude of the interaction between status on the subgrouping criteria and treatment outcome might have been larger had we enrolled a broader group of patients with neck pain, similar to that included in the study by Raney and colleagues. However, our results indicate a benefit from targeting cervical traction to the subgroup of patients with neck pain who have signs of cervical radiculopathy and do not support a benefit of further narrowing the targeted group to those who fit the criteria described by Raney et al.”Fritz JM, Thackeray A, Brennan GP, Childs JD.
No impact analysis study currently published regarding this clinical prediction rule.