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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
Case Study: Neuro Screen Client presents with acute onset of cervical spine pain that radiates into the left posterior shoulder into the triceps and flexor surface of the forearm. Asymptomatic on the right upper extremity. Limited and painful cervical AROM. Weakness of the left upper extremity. Examination of the left UE (right UE is within normal limits): • Dermatomes: Intact to light touch C6; diminished to light touch C7 (posterior UE and the entirety of digits II–III) • Myotomes: Strong elbow flexion and wrist extension; weak elbow extension and wrist flexion • Reflexes: 1+/diminished to C7 (triceps) • Special tests: (+) Spurling test on the left, (–) on the right; symptoms relieved with cervical distraction Assessment: The left C7 nerve root pathology explains the subject’s symptoms. The radial nerve innervates elbow extension and wrist extension, though the C7 myotome is responsible for elbow extension and wrist flexion. Therefore, the weakness is of a myotomal pattern; the diminished sensory fits a dermatomal pattern because sensory was diminished on the entirety of digits II–III but intact on the dorsum of the thumb, where the radial nerve and C6 innervate. Diminished C7 reflex was present, though a score of 1+ may still be considered normal in some individuals, with 2+ indicating a “normal” reflex. Positive Spurling test identifies provocation of symptoms of the nerve roots via compression of the intervertebral foramen. Case Study: Treating Cervical Spine Pain with Radiculopathy 42 y/o female housewife with 3-month onset cervical pain + R UE radiculopathy Interventions (6 weeks of treatment): • MDT • Neural mobilization with simultaneous manual cervical traction • Cervical stabilization exercises after 4 weeks • Client education: Posture, household activity modification, ergonomics Results: Significant pain reduction (from 8/10 to 1/10) and disability reduction via NDI (from 60% to 20%); significant AROM all cervical planes
Case Study: Dry Needling
63 y/o male, occupation is a desk/computer job but otherwise active lifestyle, with 5-month insidious onset headache with chronic neck and shoulder tightness Interventions (8 weeks of treatment, with a total of 5 visits at the clinic): • Cervical and thoracic mobilization with HEP on first visit; one week later (second visit) dry needling to bilateral levator scapulae + stretching and light resistance band therapeutic exercise/continued joint mobilizations • Dry needling technique: After needle insertion, partial withdrawal and three to four points targeted in a narrow cone-shaped area Results: Favorable for dry needling, as subject reported reduced or eliminated headache after each dry needling, though this case did use three types of interventions; after 8 weeks, subject denied headaches
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