Hey Folks,

I am a newly graduated physio who has been practicing for 4 months. I have a puzzling patient. I have seen her for 5 sessions and her pain complaints have improved but neuro signs and symptoms persist.

Here are some of my objective and subjective findings:

Elevated first rib.
Decreased C6 reflex.
C7 myotomal weakness.
Shoulder held in elevation and protraction.
Numbness to index and thumb.
++ Tender to palpation in medial elbow over ulnar nerve.
Burning in posterior shoulder.

Here is my treatment so far:

Heat, soft tissue massage to upper back
Manual cervical traction (no change to subjective complaints)
Strengthening of deep neck flexors, shoulder protractors
Mobilize first rib
Pec - release

What am I missing?

Thanks.

Willeseden

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