case 3-6

Question 1

50 year old fisherman - neck pain into thumb

Answer 1

C6 radiculopathy causing radicular symptoms
in (L) UL due to cervical spondylosis
pr chemical irritation of z joints
- HEP - Nerve gliding
Pain relieving positions (day and night)

Question 2

C6 radiculopathy A&E

Answer 2

• irritation of the c6 nerve root which causes reffered p&n down your arm
• Pain usually alleviates in 6w - w/out physio normally resolves but help speed up recovery an address any maladaptive behaviours/muscles weakness
  Explanation and advice - activity modification
• extending your neck and looking up and reaching your arms out far are things to avoid
• eg sleeping on back in neutral
  but advice to stay active
  Pharmacological management
  Teach pain relieving position

Question 3

40 y/o female high school teacher r) sided neck pain

Answer 3

1. (R) arm nerve lower cerviclal mechanosensitivity causing

local nociceptive pain in neck and pain.

Question 4

R) arm nerve lower cerviclal mechanosensitivity causing
local nociceptive pain in neck and pain.
A&E

Answer 4

Explanation and advice -
nerve sensitivity from when arm was jerked on bus - why massage hasn’t worked
ST is 6 weeks healing activity - tissue damaged heal and left with sensitivity
modification - avoid aggravating acitivites and repeated awakward posis - eg whiteboard
reassure - may be concerned but can compromise on some alteration to work eg use projector
- find posis of ease - sleep in neutral
but advice to stay active
Pharmacological management
Teach pain relieving position
Positions of ease
sliders may intitially inc. pain and is normal

Question 5

40 year old female engineer - WAD

Answer 5

acute injury may have resolved (z-joint)
Mechanosensitivity of (R) nerves (as pain in
arm is with repetitive arm movements; if pain
was neurological it would probably be more
severe and constant)

Question 6

WAD A&E

Answer 6

-Explanation that 50% of people will have some
sort of pain 1 year post crash.
- pain from mechnaosensitivity of nerves, deep
muscles of the neck inhibition, - dizziness and
unsteadiness likely form impaired
mechanoreceptors of the neck (need ot get
them back to understanding normal inputs) > retraining control of muscles and ensuring your posture is optimal for muscle control.
- Assess fear of pain - if fearful liase with psych
- Achknowdge that its normal to feel pain after a
crash like she had
- Provid assurance
-Encourage to reutn to activity and goal setting
. Poor posture and ergonomics could bc contributing to you pain while driving and using computer - ergo assessment
- Provide coping strategies
- emphasise self managemnt (CBT, self talk,
distraction imagery)
- Graded exposure
- Graded exercise
- impact of events scale

Question 7

WAD HEP

Answer 7

postural correction when driving/computer, SNAGs (6 reps), JPE and mvnt sense (dosage), CCFT holds (dosage above). Start with this and maybe focus on scap later.

CCFT Training: aim for 10X10 sec holds
26-28mmHg or at level assessed
Posture Correction (occipital lift) - Correct with
lumbar, thoracic and scapula, hold for 10
seconds, every 15 minutes