Hi Sharadphysiohave you looked at Travell and Symmond's book:i wil certainly check for trigger point in scalenae which i have not checked yet)
i also would like to know the muscles(trigger point) which refer pain in distal hand and fore arm.
Travell & Simons' Trigger Point Manuals (Volumes 1 & 2)
these books are old but they give great information and illustrations are impeccable. The first volume covers the upper quadrant. the treatments are more oriented towards physicians - coolant spray, needling etc. However stretching the muscle is useful and often when combined with STM and ischaemic pressure on the TPs.
Neural examination is not that reliable and I understand there is some doubt cast on its validity. At present it is still consider an essential part of the examination. A negative result could be due to:pt does not have significant positive objective finding which is a bit confusing me
a false negative - either the test was not accurate enough to pick up an impairment
a true negative - the symptoms your patient has are not due to neural deficit as such. In which case this supports an alternative hypothesis such as the trigger points or possibly an autonomic component such as in T4 syndrome.
This is why it is important to be empirical. Only introduce one technique at a time and observe the response. You can use more than one treatment at a time but never introduce techniques simultaneously. However rather than going back to this now you have established that neural mobs may have at least a partial beneficial effect. Or is the improvement just due to a change in the patient's presentation?but i am not sure about cx lateral glide which i applied during the course of treatment...so I am not sure about lat glide effectivity.
Do you mean the movements were stiff? Have a read of Maitland (vertebral manipulation). In selecting the technique usually cervical rotation (appropriate angle of flexion to emphasise the lower cervical segments) away from the side of the symptoms is a good starting point. Traction is often a second choice but you have already tried it. In choosing a technique you need to be aware that just as it can do good it can also cause harm in the case of aone more thing ....according to u which cx mobilization is effective for radiculopathy cases
i mean whether cx lat glide or unilateral post ant mobili. or plain post ant mobi
since in this particular case what i found with passive physiological movt test of cx spine-post ant mobility ,unilateral post ant mobility and cx lateral glides........were significantly reduced....any experience with this issue???radiculopathy. However I think you need to read about this. And certainly you still haven't diagnosed the problem. You have complete a thorough reassessment before going on to these techniques. And you really must know how to apply the techniques - something that can't be done over the internet.
sharadphysio I hope you won't take offence at this comment but I think it needs to be said. You obviously are interested in this area of physio but you seem quite lacking in knowledge and approach. Have you considered completing a post graduate qualification? At the very least you need to read more widely. What books do you have?
Will be interested to know how you get on with your patient.