CASE 4 - 6 Flashcards
CASE 4 - Lower cervical disorder with nerve root compression
- 50 y/o fisherman
- L) sided neck pa. that extends into L) UL
- L) thumb (c6) feels number
- symptoms at night and when looking up (this closes down the IVF
CASE 4 - Lower cervical disorder with nerve root compression
Assessment
standing = observe for protective mechanisms (hitching of shldr) and functional positions of fishing
sitting = ROM
supine = NEURLOGICAL ***, could do neurodynamic if have time but don;t want to flare
PIIVM - determine level as a more gentle approach to relax pt
Prone = PAIVM (central pa. more indicitive of disc protrusion or stenosis)
CASE 4 - Lower cervical disorder with nerve root compression
treatment - advice and education
reassure: nerve irritation is common w/ good prognosis w/ PT treatment
- usually resolves by itself but PT can increase recovery
- modify = mvmt is important w/ more focus on positions of ease and avoid aggravating posits (neck ext + with arm elevation).
- work, sleep modification important for healing
- pain management
CASE 4 - Lower cervical disorder with nerve root compression
treatment - other
o MT: Lat glide, traction, rotation or LF PIIVMS to OPEN joint so to the right
o Sliders gentle if mechanosensitivity too. Very low dose no more than reps per session so maybe 8?
- Possible scap postural correction if indicated for mechanosensitivity but less likely
SNAG?? If you can ENSURE it is to OPEN z joint
Address muscle impairment - extensors?
CASE 4 - Lower cervical disorder with nerve root compression HEP
AROM, easing positions/movements, snags?, sliders if indicated, scap correction if indicated
Case 5 = lower cervical disorder w/ nerve mechanosensitivity
- 40 y/o teacher
- r) arm & neck pain
- sudden jerky vmt of arm and neck
- symp. aggravated by repeitive mvmt of r) UL
Case 5 = lower cervical disorder w/ nerve mechanosensitivity
assessment
Standing: observation, scapular assessment/correction, functional movements – repeated arm movements - blackboard writing
o Sitting: ROM, Postural assessment/correction, Spurlings?
o Prone: PAIVM if not too irritable* scap hold test if indicated by scap assessment and retest paivm
o Supine: ULNT* PIIVM less sensitive if irritable*
Case 5 = lower cervical disorder w/ nerve mechanosensitivity
treatment A&E
sensitivity of nerve due to jerky movement - why massage not working
- generally ST heals w/in 6 weeks so no damage just sensitivity - alarm
mvmt - important to move > find posis of ease and avoid aggravating posis (reaching, stretching activities or contralateral LF worse in arm abd)
modifications - w/ work to prevent reaching up (eg projector writing), comfortable sleep fpr healing
PT - has good prognosis - explain of sliders how may initially cause pa. but will work within pa. limits
refer for pa. meds
Case 5 = lower cervical disorder w/ nerve mechanosensitivity
treatment
o Sliders (low dose and do slowly and gently, 8 reps daily. Expect slight increase in pain initially o Manual therapy*: lat glide, traction, (if i were to do LF piivms it would have to be towards side i think? Bc of sensitizing maneuver thing?) o Scap hold exercises if indicated - dose depends on assessment
Case 5 = lower cervical disorder w/ nerve mechanosensitivity HEP
HEP: Sliders, scap holds, AROM
case 6 = Chronic whiplash associated disorder
- chronic whiplash
- 40 y/o engineer
- 5 months post MVA
- persistent r) neck pa. + pa in r) arm w/ driving/computer
- mild dizziness (reading when standing)
case 6 = Chronic whiplash associated disorder
ax
o Standing: Observation, scap assessment/correction, functional standing position, Vestib check**
o Sitting: ROM (combined - to direct treatment), Postural assessment/correction, functional positions (driving and computer), VBI** and vestib? - in standing section above, JPE and movement sense* SPNT, Spurlings - if not too irritable to determine if muscular or nerve may save need for neurological
o Prone: PAIVMs, scap holds if time
o Supine: Neurological Neurodynamic if time CCFT* if VBI clear bc good S & S
case 6 = Chronic whiplash associated disorder
advice and ed.
Whiplash has a lot of associated symptoms
- 6 weeks healing for ST so most tissues should have healed and symptoms a result of sensitivity (alarm)
modify = mvmt is important within pa. limits, don’t avoid mvm > important for healing and prevent stiffness
- focus on dizziness and mvmt control > looking at posture and specific eye mvmt exercises
- potentially worth having an ergo assessment of how drive and work
- work, sleep modification important for healing
- liase w/ psychologist for PTSD
- pain management
case 6 = Chronic whiplash associated disorder
o Postural correction exercises while driving and using computer - every 15 min for 15s or every red light - cues.
o Scap control/holds. Side lying to start. Either just action. 5 x 5s holds. Progress to long holds and reps, to sitting, to more functional
o CCFT exercises 10 x 10s hold at lowest correct level from Ax or just CCF action*
JPE & movement sense (dosage)* more of a priority bc of dizziness
o Manual therapy: Depending on irritability as to whether to open or close joint - rtn piivms or LF piivms, unilat paivms. All grade 3 for range and pain relief. Start with 2 if more irritable. SNAGs* - both kinds 6 reps (like MWM)
