peripheral neuritis!!

[junior_physiotherapist]

hi all:

would some one plz enligthen me on this disease & it's physiotherapy as i have a patient his history:
53 yr.,male, hard worker (green grouser), smoker, negative hematological tests & chemistry 1 tests, normal x-ray,diagnosed by his ortho physician "neck pain radiated to RT.shoulder ", numbness along his both upper limbs more at his hands,.
severe to moderat limitation at his NECK ROM ESPECIALLY extension ,sever to moderate neck muscle spasm, no other health problems.

my ? is if there is any miss assessment items.
any suggestins for a plan treatment of physiotherapy


kind regards

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[ramywhite]

Hi junior_physiotherapist,
The title is "peripheral neuritis" but the orthopedist diagnosed as "neck pain radiated to RT.shoulder". I know this isn't a diagnosis at all. But why you said it is peripheral neuritis?
I suppose we need more assessment for this patient as MRI to exclude cervical disk prolapse. Also present history may reveal something if the condition starts while he lifted weights or after he waked up in the morning or else. Both side numbness may indicate compression on spinal cord.
You can start with dermatome and myotome in your assessment that will tell you many things.
regards

[sdkashif]

Please, describe the history in a bit more detail. For how long the patient suffers from that condition? Any history of trauma? Is there involvement of any other other joint? Does the patient also suffers from any other associated conditions? Rule out the RA or AS by noting other features? Rule out tuberculosis or other pyogenic infections? Any possibility od spinal tumours? Keep the differential diagnosis in mind always?

On examination note the poture of cervical spine. Whether it is straight, lordotic, kyphotic or torticollis? Measure the range of motion of cervical spine and note which movement is limited and which provokes more pain? Note the spurling's sign. chech for test for cervical outlet syndrome? Examine for peripheral nerve compressions like median nerve compression. Look for radiculopathy and cord signs including the long tract involvement. Perform a routine neurological examination both for upper limb and lower limb for any upper motor neurone sings. Perform sensory, motor and reflex testing examination for that. Tell us about your findings.

[davidjack]

hi his neck assessment shows he has problem in cervical region.it may be early stage spondylosis,just go for detailed assesment of his cervical region & rule out nerve root irritation (brachialgia).it may be neuritis if he is diabetic,but that too not symmeterical (both hands simultaneously)
just check out

[physiobob]

Yes you have forgotten to mention aggravating factors, how long this has been going on and importantly what are the results of his neuro-examination i.e. reflexes and manual muscle tests. You need to confirm the presence or absence of nerve root involvement first and we need to learn about the irritability of his condition from you before we can advise further treatment options.

I thank the others in this forum to stating this already and hope everyone will begin to provide more thorough, more specific presentations. You should know the methods of clinical assessment from your training? or is it not taught so well in your country. It the later is the case, we can assist you there with a medical assessment history taking and planned approach to treatment.

[junior_physiotherapist]

hi all


*Many thanks to all of ur relevant information,

*i have mentioned previously normal x-ray ,so any cervical curves abnormalities i think were excluded!!,normal blood tests also mentioned to exclude diabetus!!

*this pateint was complaining a year ago there is some electric shocks at his both U.L.especially through sealing things to customers"at winter season"
i explained this may due to attractive forces between charges of his wool clothes,now his complain has began since 3 weeks ..

**munual muscles tests grades (3-4)/5 for neck &shoulder girdles
**EMG showed mild bilateral ulner nerve compression/irritation..

regards