Hey everyone,
Got a patient who has had a long history (> 3 years) of neck pain referred to the shoulders and arms/hands (bilat). Occasionally he would get pins and needles down the left arm and rarely in the right arm. His pain is greater on the left than the right.
On physical examination, he was hypomobile and TOP/pain on PAIVM @ C3,4 and C4,5. He had a limitation in Cx rotation to the left but he has now acheived full rotation (R=L) He is a heavy built, tall, fit male and doesn't have the best posture. It was concluded from this and other physical examinations that it was a postural/loading disorder. The patient has attended several sessions thus far, and has improved greatly but pain still persists with the occassional P+Ns senseation. He benefits mostly from STM of UT and LS and taping of his shoulders to improve posture. I've done PAIVMs @ the aformentioned levels and now has full rotation.
In the previous session I PPIVMed him at C3,4 4,5 to off-load the joint after a discussion with the supervisor. 2 minutes after Rx, the patient experienced P+Ns on the left arm. 5 minutes later he experienced P+Ns on the right arm.
We advised the patient to come back next week (which is this week) to be re-assessed as we're unsure of what is happening. I was hoping to get some ideas of whats going on, what have I done or what have I not done.
Cheers
1 comment:
What you have down sounds good, but you may have pushed him too far/over treated the pt. With nerve involvement you get latent pain and this may be just that but it has come on quickly. What also may be possible is that the pt had a stiff neck because it was protecting the nerve from being irritated so all this lossening up of the joints and extra movement has irritated the nerve
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