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Urgent help needed...
Hey guys,
Plz help.. i've a lady patient 27yrs, with pain and numbness down both upper arms.. since 4 yrs.. got her x ray done.. there is rudimentary cervical rib and also osteophyte formn and some signs of degeneration at C3,4 ..
its a tough one for me coz i've started practising recntly.. Plz help me with a treatment plan... how benefitial will the treatment be and how many sessions wud it take...
thanks guys...
Read about Thoracic Outlet Syndrome which will help you on your way. remember there are 3 major sites where the nerve can get trapped and this has a big influence on the problem.
You name there is some degeneration of C3-C4 and nerves from this area will innervate the intrinsic muscles of the neck which can become over active and give more compression on the affected nerves which cause arm problems. By the way does the area of armproblems (dermatome/sklerotome/myotome/joint) correspond with area of cervical rib? If not the problem might lie somewhere else. How did it start? For example carrying a backpack. General posture? (how is the muscle balance anterior posterior?)
How is the general mobility of the cervical and thoracic spine (If there is a problem at a certain level due to hyper mobility hypo mobility of segments nearby will increase the problem)
I have to stop but will come back on the subject. Cheers
hey,
well i did all the assessment.. there is no problem with thoracic spine mobility... cervical spine ROM is restricted almost in all directions due to pain...
Also patient is negative for thoracic outlet.. all tests negative..
and the symptoms are in the C3,4 dermatome, myotome... so guess its more of CS at C3,4 than a cervical rib case...Quote:
Quote:I wud like to discuss efficacy of Roos' test but thats a separate topic...
I did some manual traction with other electrotherapy stuff.. seems to work well for the patient...
One problem of the patient i'm unable to understand.. "she says in her arm it feels that her nerves are gettin on each other or she feels shooting pain just in the arm region, laterally and no where else"
wat do i understand from this...
cheers..
I think I would back the bus up a little and follow suggestions of f the ealier post on a thorough screen of dermatomes, sclerotomes, myotomes, and communicate with referring physician. Me thinks there is adequate indication for anMRI and CT scan. this is such a young person for such sx, yellow to orange/red flags flying high.
jerry hesch, mhs, pt
Have a look over these articles
Brachial Plexus Compression: “Thoracic Outlet Syndrome”
PHYSIOTHERAPY REPORT-A STUDY OF ACCEPTED MEDICAL
MISADVENTURE CLAIMS
hi,
u have 2 look for proper dermatome & myotome involvement. chk ULTTs 4 the neural component.
the shooting pain could be due to C5-6 involvement.
rule out the red flags carefully betore treating.
i would suggest an
if the pain is not so severe then u approch some mobilisation. stretching of trapizius ms and apply some hot pack to that area. if the pain is to much concedering the thoracic outlet syndrome the approch is surgical.in mild case phonophoresis is also helpfull.
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Your patient may be suffering from both problems at the same time- Cervical rib ( a part of thoracic outlet syndrome) and Cervical disc syndrome. So you have to address the both problems at the same time.
Asses range of motion ROM of Cervical spine, thoracic spine and shoulder joint. Assess areas of hypomobility and hypermobility in cervical and thoracic spine and any restiction in shoulder area. Assess the mobility of first ribs.
Assess tightness or spasm in muscles around cervical spine, thoracic spines, shoulder girdle, around glenohumeral joint and in upper limb.
Assess weakness in muscles around cervical spine, thoracic spine, around shoulder girdle, glenohumeral joint and upper limb.
Assess posture of patient especially cervical spine, thoracic spine and shoulder girdle.
Pain and inflammation in the thoracic spine can be relieved by use of modalities like heat, cold, diathermy, ultrasound, TENS, intermittent traction, etc
Mobilizations, manipulation can be used to increase range in the cervical spine, thoracic spine and shoulder girdle and joint and first ribs.
Tight muscles and fascia can be lenghtened or stretched by myofascial therapy of Stretch and spray, slow sustained stretching, Hold Relax and Contract relax PNF techniques. Muscles needing attention are scaleni, trapezius, pectoralis minor & major and other muscles around shoulder.
Muscles which are assessed as weak muscles should be gradually strengthened ny resisted and isometric exercises especially muscles shoulder girdle elevators and around the spine muscles & muscles of upper limb.
Poor postures should be corrected and good posture should be taught.
Any aggravation factor should be analysed and resolved.
quote:she says in her arm it feels that are getting on each other.......she feels shooting pain in the arm region lateraly and nowhere else.(Utkarsh777)
shooting pain= trapped nerve. lateraly in lower or upper arm? likely nervus radialis. But not C3-C4! or do you mean from neck to shoulder? So is there a different mobility on the lower levels of the neck C5-T2?