Transcript Cervical Spine Evaluation and Treatment The Role of

Initial Evaluation

Thoracic Spine ROM
– decreased in left
sidebending and extension
– pain reproduced with right
rotation
– Decreased kyphosis from
T3 - T7 in upright and full
flexion

Segmental Mobility
– P-A glide hypomobility
from T3 - T7
– Posterior shoulder pain
reproduced from T4 - T6
University of Delaware

Rib Mobility
– P-A glide hypomobility in
ribs 3 - 7 bilaterally
– Posterior shoulder pain at
left ribs 4 -6

Palpable trigger points
– Left rhomboid and mid
trapezius
Initial Evaluation

Shoulder AROM

L
R
Lower Traps
3+/5
3+/5
Shoulder Muscles
Mid Traps
4-/5
4/5
– Unable to assess
secondary to pain
Rhomboids
4/5
5/5
Serratus Ant.
4+/5
5/5
– Elevation and external
rotation full but painful
on the left

Scapular Muscles
University of Delaware
Initial Evaluation

+ Neer’s and Hawkins Impingement Tests

Scapulo-humeral rhythm
– Decreased eccentric control in descent of the left arm

DASH Score
– ADL Score
– PA Score
17%
25%
(McConnell, et. al. 1999)
University of Delaware
Hypothesis

Patient had
hypomobility and pain
in the upper thoracic
spine and ribs
– Movement of the joints
recreated and referred her
pain to the shoulder

Lack of scapular muscle
control decreased her
ability to set the scapula
– rotator cuff symptoms
University of Delaware
T4 Syndrome

Maitland, 5th ed., 1986
– Describes T4 syndrome as symptoms of an illdefined nature causing symptoms in the arm or
head.
– This can apply to any of the segments between
T3-T7

Stralka, April 2000
– Mobilization of T4 decreased pain in patients
dx. with Complex Regional Pain Syndrome
University of Delaware
Winters, et al., 1997

Manipulation to
surrounding structures in
patients with complaints
originating from the
shoulder girdle are more
effective when the
shoulder pain is not
related to decreased ROM
in the glenohumeral joint
University of Delaware
Thoracic Position on Shoulder ROM &
Strength

McClure & Pratt (1999)
– Decreased muscle force and
shoulder abduction ROM when
the thoracic spine is in a slouched
posture
» Decreased scapular upward rotation
and posterior tilting, and increased
superior translation
University of Delaware
Intervention

Early Intervention (Treatments 1 & 2)
– Manipulation/Mobilizations Thoracic Spine and Ribs
– Electric Stimulation
» Trigger point stimulation
» TENS with ice

Pain range decreased to 0-3/10
– Played in a concert for 2 hours without pain
University of Delaware