A 26-year-old female presents with right-sided neck pain that radiates down the posterolateral upper and lower arm with mild aching in the index finger and thumb. The patient reports that her symptoms began approximately 2 weeks ago following a lifting accident at work. The patient also reports that the pain becomes severe every time she turns her head to the right. Following the accident, the patient went to the emergency room where she was diagnosed with a cervical disk herniation and an anti-inflammatory was described in addition to analgesics. The patient has no history of medical arm pain and no medical or surgical history of relevance.
Given this brief history, what are some of the diagnoses you would include in your working hypotheses?
In addition to cervical radiculopathy, some of the diagnoses to consider should include muscle strain, and ligament sprain.
Does this patient warrant an upper quarter screening examination?
Given the diagnosis, reports of symptom radiation and severe neck pain with head turning, this patient warrants having an upper quarter screening examination.
The upper quarter screening examination revealed the following findings:
- On observation, there was no evidence of obvious deformity or atrophy.
- Active range of motion of the cervical spine revealed flexion (30 degrees with reproduction of neck pain), extension (20 degrees limited by spasm of neck muscles and arm pain), left rotation (no deficits but reproduced mild neck pain), right rotation (35 degrees limited by spasm of neck muscles and arm pain).
- Cervical compression reproduced and neck pain, whereas cervical traction had no effect on the patient’s symptoms.
- P-A pressures were normal except over the C5-6 level, which caused local pain and spasm.
- Sensation testing demonstrated loss of pinprick and light touch sensation over the radial aspect of the right index finger and over the dorsal aspect of the thumb.
- Deep tendon reflexes testing revealed a diminished biceps reflex on the right (1+); otherwise all other reflexes were normal.
Based on the findings from the screening examination, has your working hypothesis been confirmed?
The findings from the screening examination confirm that there is neurologic involvement and indicate a cervical disk compression with C 6 motor and sensory radiculopathy.
Will this patient benefit from physical therapy?
If the working hypothesis is correct, the patient should benefit from physical therapy.
If you plan to treat this patient, outline your intervention.
The intervention will include a trial course of cervical traction, AROM of the cervical spine (initially avoiding rotation and sidebending to the right), cervical isometrics progressing to more aggressive strengthening based on patient tolerance, the ...