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1.Patient's profile 55 years old male. occupation:taxi driver 2.History 18 Mar.1998 he developed aching from neck to shoulder without apparent reason. He cannot go to work for the pain. At 31 Mar. he had a numbness from his shoulder to top of his finger. 3.Examination by orthopedist (1)cervival spine Motion is stiff toward all direction. Neck pain is aggravated by right side bending. Tendernss exsists from right M.Trapezius to posterior axillaris. (2)pathologic reflex Wartenberg(-) Hoffman(-) Babinski(-) (3)MMT (Daniel) Upper extremiy ;all normal (4)Sensation hypesthesia in right C6-C7 dermatome area (5)Tinel sign (-) Phalen test (-) (6)ROM of shoulder is full range. (7)X-ray shoulder;normal neck;clasification in spine canal at C5 level (OPLL suspected) (Plan) Further inspection by MRI is needed. --------------------------------------------------------------------- (Question) It seems that this case is wanting in more other assesments by PT. But we cannnot do anything without referral. I think I will be unable to get refferal of this patient because Japanese medical doctor don't know what PT can do. Would you teach me what treatment PT can do? Indication for manual therapy,exercise,education? Can PT remove the pain? I am now studying back pain treatment from books for myself. Sincerely, HIRO WOOD JAPAN %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%