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47-Year-Old Male EndodontistDiagnosis: Chronic neck pain and right thoracic outlet syndrome.Patient history: Patient reported a history of an extensive medical workup, with over four (4) years of intermittent right upper extremity tingling and numbness, as well as severe, intermittent right cervical and upper trapezius pain. All symptoms worsened with working in a forward bent and right sidebent position for several hours a day. Patient expressed his reluctance to be in physical therapy at his initial visit, because he had not achieved favorable results with previous physical therapy treatment attempts. Patient admitted he agreed to attend the initial evaluation appointment only because his wife, a former patient, had requested he do so. Significant findings: Patient presented with severely limited left cervical sidebending, with right cervical and upper trapezius pain at end range of motion. Patient also presented with palpable hypertonicity and tenderness to palpation in the right anterior cervical musculature, right scalenus anterior, right upper trapezius, right pectoralis minor, right subclavius, and right biceps. Patient reported decreased sensation throughout his entire right upper extremity. Right shoulder flexion, abduction, and external rotation range of motion were limited and painful, at end range of motion. Intervention: Patient was treated twice weekly for 8 weeks, then gradually weaned from treatment over the next 8 weeks. Treatment consisted of an ergonomic assessment of the patient’s work environment, with recommendations for behavior modifications to avoid aggravation of his condition, therapeutic exercise, and a neuromuscular treatment approach to the hypertonic and painful soft tissue structures of the right upper quadrant. Patient was also instructed in self-treatment techniques, incorporating neuromuscular treatment principles, for the occasional aggravation of his condition that 8-10 hours a day at work would cause. Outcome: Patient was discharged to self management of his condition, reporting a 90% reduction in the symptoms he had originally presented with. |
