Scenario 2

Question 1

C6 nerve root compression of 3 weeks duration – gradually improving, what Assessment ?

Answer 1

Neural checks – Dermatomes (sensation, light/deep, hot/cold), myotomes, reflexes

Vertebral artery checks – Cx rotation to one side, hold for 10 seconds, return to centre for 10 seconds – any symptoms? Repeat to other side.

Question 2

Signs and symptoms of VBAI

Answer 2

Symptoms include 5ds, 3ns, 1H:

Drop Attacks			Nausea		Headaches
Dizziness			Numbness
Dysphagia (swallowing)	Nystagma (eye shaking)
Dysarthia (speech)
Diplopia (double vision)

Question 3

What Manual therapy test could you use to Ax?

Answer 3

Need to discuss further

Question 4

Treatment option?

Answer 4

Treatment
In most appropriate order

Lateral glide – from right side, will open left side and relieve pain

Traction - good for any neck pain

If Obj Ax shows a McKenzie directional preference (ext and left rotation reproduces pain) and flexion relieves pain, the ‘shotput’ Cx flex. technique may be appropriate

Question 5

Exercises

Answer 5

Right rotation

If directional preference is flexion, flexion exercises

Question 6

Problem List

Answer 6

Constant burning pain
Sharp pain on movement
Pain on extension or left rotation

Sub markers – VAS score for burning pain and sharp pain
Obj markers – Degree of extension or left rotation before reproduction of pain (goniometry)