Download - Case presentation 221(2) sandamail
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