neck pain with referred pain

[Netty]

Hi,

Perhaps you can give me some suggestions.

I currently have a male patient 46yrs whom for two weeks has had numbness in thumb and 2nd and 3rd fingers. He thought he had carpal tunnel syndrome. However Tinsel test etc were negative and shoulder and neck tests were all negative apart from C/Sp Right rotation which had limited ROM and caused pain and dermatomes positive. This movement when isolating C6/c7 cause an increase in numbness. I carried out mobilisation and desenzitized the neural tissues. I am seeing him again next week should I just carrying on treating in same way or should i be doing anything else. And how long do you think it will take for the numbness to subside?

Thanks

Netty.

[Ruth]

Hi Netty,

You didn't mention whether you are a physiotherapist or sports therapist etc?

Either way, you need to use your own clinical reasoning skills to identify how your client is responding to the treatment and then either continue or progress as you see fit. Relate what you are seeing to the anatomical knowledge you have, and consider whether the ultimate cause of the neural symptoms has been resolved or not. You did not mention whether the symptoms are L or R sided?

If it's an osteophyte or other bony anomoly that is causing the problem then the prognosis is somewhat different to someone who has tight scalenese due to whiplash, for example.

As for when the neural symptoms will ease, that depends on the level of damage there is to the nerves really. If whatever was causing the problems has been alleviated with your mobs & desensitising (assuming you used neural glides?) time will tell what damage has been done and how this will recover, or not, as the case may be.

Without knowing your client's full case history it is somewhat difficult to make a prognosis as I am sure you can appreciate! Have they got an ongoing rehab plan, and been advised on lifestyle changes if it's a work-related problem?

Good luck and let us know how you go!

[Netty]

Hi Ruth,

Many thanks for your reply.


I did a 4yr physio course but have the title of sports therapist but work along the lines of a physio more than a sports therapist!!!!!!!

Saw patient again today and he had no reduction in numbness.

I do feel this is the result of a neck problem (having carried out Active, passive , resisted, PPIVM, PAIVM etc, though reflexes were normal and sensation only at dorsal of 3rd finger positive, palpation along median nerve caused increase in numbness).

I treated by gentle mobilisations of facet joints etc and also soft tissue work to upperback and neck. What would you suggest as further treatment I could give..........I am seeing the patient again next week and would like to see some improvement by then!

Your suggestions would be appreciated

Thanks

Netty

[ben232]

hi Netty
how did your patient get on?
A colleagues wife had a similar problem, but a lot of pain as well. MR showed a C6-7 disc hitting the C7 nerve root and after 6 weeks of physical therapy...(she didn't want surgery)...she gave in and had the disc out. She is back to normal now. I would alway go for a good therapist first in this situation.
Ben