UCP/AL/11/221

E.K SANDAMALI

Allied Health Sciences Unit

Faculty of Medicine

University of Colombo

CASE PRESENTATION[Musculoskeletal Module]

SUBJECTIVE EXAMINATION

Name: Mrs. Indrani

Age: 62 years

Occupation: Dancing Teacher

Present Complain: Neck Pain (Numeric Pain Scale- 5)

Onset: Gradual onset, Before 6 months

Pain location: R/S of neck

Pain Type: Aching Pain

Pain Radiating or localized: Radiating through arm, forearm,

ring and little finger

24h behavior of pain: pain is more at night

Sensation: Parasthesia over medial forearm, No vertigo or tinnitis,

Easing factors: lying position

Aggravating factors: Neck Extension and lateral flexion to same side

of pain

SIN factors: She can sustain positions, and pain reduced

immediately after aggravating movements

Function: No pain in swallowing

Past medical history: No Diabetes, HTN, Cholesterol

Past surgical history: No

X - Ray – Intervertebral Disk space has reduced. Osteophytes over C5, C7, T1 vertebral bodies

OBJECTIVE EXAMINATION Observation

Anterior : Unequal shoulder level – R/S shoulder is elevated

Lateral : Cervical lordosis has reduced Shoulders are slightly protracted

Head thrust slightly forward

Posterior : Scapulae are slightly abducted

Palpation

Tenderness over C6, C7, T1 spinous processes.

Tenderness over C7-T1 and T1-T2 facet joints

Tenderness over R/S cervical paravertibral muscles.

Jump sign is positive.

• Trigger points on upper trapuzius muscle.

Test Cervical quadrant test (VBI Test) - Negative

AROM - (Tape measurement) Normal • Cervical flexion - 9cm 9cm• Extension - 7cm (limited and painful) 9cm• lateral flexion - R/S- 3cm (limited and painful) 5cm

L/S- 3cm (limited and painful) 5cm

• Rotation - R/S- 5cm (limited and painful) 9cm L/S- 5cm (limited and painful) 9cm

• Checked Shoulder flexion. Extension, Abduction, Adduction, Medial rotation and Lateral rotation (Normal)

• PROM is also limited because of pain

O’Donoghue’s Maneuver

Compression Test – Positive• Radiating through R/S arm, forearm and ring and little finger

Jackson Compression Test – Positive• R/S - Radiating pain through arm, forearm and ring and little finger• L/S - Negative

Flexion Extension compression Test – Positive• Flexion – No pain• Extension – Radiating pain

Adson’s test - Negative

• Lateral flexion, Extension and rotation caused radiating pain (Muscle strength grading – Grade 4)

Physiotherapy diagnosis

Condition - Cervical spondilosis

• Radiating pain mainly C8,T1 area.

• Paresthesia over C8 area.

• Cervical extension, lateral flexion and

rotation are affected and limit the ROM

Pain radiates because R/S nerve root compression because of

osteophytes and narrowing of intervertebral foramen.

Plan of treatmentShort term goals - Pain relief

Reduce muscle tightness Restore ROM

Muscle strengthening

Long term goals - Restore normal functional level Improve quality of life

Pain relief – Shortwave diathermy, 15min, 2 times per week, continues mode

Radiating pain – Cervical traction (intermittent)

Reduce muscle tightness – Kneading on upper trapezius muscle

Static friction to release trigger points

Restore ROM – Active range of motion of cervical region

Muscle strengthening – Isometric strengthening, 10 repetitions & 2 sets per day

Justification of the plan of treatment

Shortwave diathermy – To increase blood supply and remove waste products

Cervical traction – To widen the intervertebral foramina & reduce pressure on nerve roots

Kneading - To break the adhesion

Static friction - To release trigger points Active range of motion – To improve the range of limited

movements

Muscle strengthening – Increase strength of the muscle to reduce load on cervical joints

Outcome measurement of the intervensions (Progression)

Pain - Numeric Pain Scale - 4

ROM of cervical movements – Tape measurement (Measure the improvement)

• Extension - 7.5cm • Lateral Flexion L/S & R/S - 3.5 cm• Rotation L/S & R/S - 5.5cm

THANK YOU