Case Study: Physical Therapy for Management of Neck & Upper Limb Pain

by Jenny Messinis, PT, DPT

 

Capital Area PT Case Study: Neck Pain & Upper Limbs

In this physical therapy case study, neck pain and upper limb pain is addressed, focusing on helping resolve pain without injections or surgery!

History

A 45 year old woman presented with complaints of recent increase in a chronic issue of neck pain, this episode also including pain in her left shoulder and arm and tingling in all fingers of her left hand. Her symptoms were worse with prolonged sitting at work when she uses her computer and with turning her head when driving and grocery shopping. X-rays showed degenerative disc disease and narrowing within her spine.

Evaluation

At the patient’s first visit, a variety of objective measurements were taken to assess her baseline function and assist the therapist in building an individualized plan of care. Some of these measurements included: neck and arm range of motion, strength, nerve functioning and tension, palpation of muscles in and around the upper quarter, and postural assessment.

Treatment

  • Visit 1: We waste no time! Treatment at the patient’s initial evaluation included extensive education regarding ergonomic sitting posture with a focus on head and neck positioning, shoulder and upper back engagement, and the use of a lumbar support roll to help align her posture from the foundation of her spine. Massage, joint mobilizations, and muscle releases were performed at the neck and shoulder. Instrument assisted soft tissue techniques were performed at the neck and along her nerve distribution in her left arm. Her homework included neck exercises for positioning, body awareness, and improved endurance as well as nerve glides.
  • Visit 2: The patient returned with no left arm pain or tingling in her hand since initiating her home exercise program. Her neck was still sore with rotation and looking down. Overall her symptoms were improving and displaying a phenomenon known as “centralization,” which means we’re moving in the right direction! The session included similar soft tissue and joint mobilization techniques as on the first day, adding in thoracic mobility and active range stretches and functional patterns for her arms and shoulder blades.
  • Visits 3-10: Sessions focused on improving cervical motion, manual techniques to assist mobility and reduce pain, progressive therapeutic exercise aimed at postural stability and endurance, scapular mechanics, and functional movement patterns such as pushing, pulling, and lifting. Kinesiology tape was used intermittently as a postural reminder and for tone reduction.

Results & Follow up

The patient returned to PT following a two week hiatus in services. She reported full return to her daily work and leisure activities without pain or limitations. She reported continuation of her neck stretches and the use of the lumbar support roll at work regularly. If she experienced signs of possible symptom provocation, her home exercise program helped lessen or totally eliminate her symptoms. The objective measures initially assessed on her first visit were re-assessed and significant improvements were observed.

For more information on this case study on physical therapy for management of neck and upper limb pain, or to make an appointment for an evaluation or treatment, contact us at one of our two physical therapy clinics in Malta and Queensbury NY.