A 45-year-old woman awoke with right-sided neck pain 10 days earlier. The pain was localized over the right neck. She related that the pain was aggravated in all directions of movement with pain at the end of range. The previous day, the patient had been painting the ceiling in her kitchen using her right upper extremity. The patient described no neurologic pain or paresthesia and reported no difficulty swallowing, eating, or speaking. There were no complaints of vertigo, blurring, dizziness, tinnitus, or unsteadiness of gait. The pain levels and intensity have lessened slightly since the onset. Further questioning revealed that the patient was otherwise in good health and had no reports of bowel or bladder impairment, or night pain unrelated to movement.
What do the reports describing no neurologic pain or paresthesia tell you?
The reports describing no neurologic pain or paresthesia indicate that a nerve root or peripheral nerve impingement is unlikely.
What does the motion pattern of restriction/pain tell you about the stage of healing?
Pain associated with all directions of movement typically indicates acute injury.
Does this presentation/history warrant a scanning examination? Why or why not?
Although there are no obvious signs and symptoms of a serious pathology, because the onset was insidious and because the symptoms are located close to the spine, an upper quarter screening examination would be warranted.
At this stage, what would be your best guess at a working hypothesis?
The best working hypothesis at this stage would be a cervical strain/sprain.
What do the reports describing no bowel or bladder impairment or night pain unrelated to movement help determine?
The clinician uses these questions to help rule out more serious causes the patient symptoms. Bowel and bladder changes could indicate a cauda equina lesion, while night pain not associated with movement could indicate the presence of a neoplasm.
Having made the diagnosis, what will be your intervention?
How would you describe this condition to the patient?
In order of priority, and based on the stages of healing, list the various goals of your intervention.
How will you determine the amplitude and joint position for any planned manual techniques?
What would you tell the patient about your intervention?
Estimate this patient’s prognosis.
What modalities could you use in the intervention of this patient?