Cervical Spondylosis with left sided breast/chest heaviness?

[msk101]

something else to try...I'd like to suggest if it seems like the left shoulder is "dropped" relative to the thorax and in comparison to the right side (secondary to poor neck function) as opposed to needing to stretch traps and lev scap, perhaps manually elevating the shoulder girdle (you can tape effectively under the scapula to try this) will unload the brachial plexus and can relieve symptoms in the arm inc swelling, neuro-vasc. if the taping works then strengthening deep neck flexors, rhomboids, central deltoid, and shoulder shrugs can do this actively.

[jacinta]

Hi all,

these are my latest finding which I somehow thk the pt is'amazing'.
I must apologize that it'll sound kind of bored as it's bit long.


Hx
off physio for 6/12 & back again now.
previous history taking was imcomplete d/t manage by other PT.
back pain since 12 yrs ago

Observation
trunk flx/ext severely limited; flx from hip
Low. Tx - Lx spine mobility: poor, mvt : poor quality
trunk rotation: bilat. limited at outer range with TRP
bilat wide area of muscle bulging -
2 noticeable lumps inf. to Lt. Scap; 1 smaller lump inf. to Rt. Scap

Kyphotic posture with rounded shd, no imbalance in both shd height; poked-chin

Palpation:
trigger points at Lt. T5-T8 & Rt. T6 tender on palpation, VAS : 7/10
, crepitus produced on palpation.
broad area of muscles spasm all the way down from bilat. upp traps
to bilat. Iliac crests. width about 4in' on each side.
deep palpation revealed spasm +++

PPIVMs: (P-A glide)
Level & Pain at
C2-C5 G II
C6-C7 G I
T1-T3 G II
T4-T9 G I
T10 - L2 G II
L2 - SIJ G III

A-P on clavicle & costocondral joints
-pain at G II

Inf. glide of 2nd - 4th ribs
- pain at G II

it seems her Lt. chest problem is of Tx origin.

As Jerry suggested, mobilising with rubber ball slightly reduced her Lt chest heaviness, but done in supine.
I was unable to progress further than G II glide, be it P-A, A-P, or inf. glide d/t pt claims to feel highly 'sensitive' if i increase the pressure.

By the way, sharileedahl, trigger points release is done in every rx.
her feedback: ' it helps me a day or two; last longer IF i stretch sometimes'
(pt. doesnt keep up exercise; dont involve in any sport at all)
anyhow, I continue it to ease her pain a little bit to give her some good sleep.

stretching was taught as home prog.
focusing on trunk rotation & flx stretch and ext. of upp. back. in std.

hopefully next week,she comes with some improvement.
thanks for all the replies guys, i appreciate that.
Hope to hear more opinion from everyone, problem yet to be solved


sincerely,
jacinta

[jacinta]

Hi msk101,

thanks for bringing up the idea of relieving brachial plexus.
I shall look into that in her next rx.
appreciate that.

sincerely,
jacinta

[jacinta]

hi all,

some update here.
the pt returned 2/7 ago and claimed pain reduced.
She went for swimming and kept up strecthing ex at home 2x/day
said that generally symptoms eased off a lot as compared to previous.
able to sleep well.

on examination,
- bilat. upp traps less spasm.
- generalized spasm on the whole upp. to low. back had reduce
- lumps med. to both scapulae still present. only less sensitive to touch and MFR.- SIJ mobility increased
- AROM mildly improve

tests:
adson's : -ve
neural tension: +ve
----------------------------------------------------------
Previous Ax:
PPIVMs: (P-A glide)
Level & Pain at
C2-C5 G II
C6-C7 G I
T1-T3 G II
T4-T9 G I
T10 - L2 G II
L2 - SIJ G III

A-P on clavicle & costocondral joints
-pain at G II

Inf. glide of 2nd - 4th ribs
- pain at G II
-------------------------------------------------------------
Latest Ax

PPIVMs: (P-A glide)
Level & Pain at
C2-C5 G III
C6-C7 G II
T1-T3 G III
T4-T8 G II
T9 - L2 G III
L2 - SIJ G IV

A-P on clavicle & costocondral joints
-tolerate G III

Inf. glide of 2nd - 4th ribs
- not done due to breast tenderness as pt having menses

I continue
-joint mob (PPIVMs)
-MFR
-Manual neck traction & stretch
- nerve glide was introduce. initially with only Lt. UL. in shd. 90 dg abd. elb. ext; then progress both ULs; then progress with head loading by Rt. lat flx
- On posture part, I re-enforce correction and education.
encourage a lot of head retraction ex. in upright sitting ( so that pelvic in neutral to avoid Cx spine malalign)

feedback:

-initially c/o pain increase ++ on nerve glide, slowly reduce after 20 glides.
-c/o 'tightness' when 2 ULs gliding together,
- on loading, pain eased off by half after 50glides. (of course, she c/o ULs tired but feel much relief)

pt been advised to keep up swimming & stretching. As long as her Tx spine mobility gradually improve, i thk her prob with Lt. chest shd be solve soon.



jacinta