Henry,
I'mnot sure sure he has a pure nerve root compression. If this were so I would anticipate a more distinct dermatomal pattern. You suggest Axillary nerve, but this would give p+n over the deltoid region. I am still thinking he may have a sympathetic referral from his thoracic spine. It may be cervical though. Thus what you need to do is find out what causes his P+N ( or see if he has them when he comes in). Then mobilise his cervical spine only. If the P+N get better it is the C/S. I would use PPIVMS rather than PAIVMs. Also, assess his neural system. which nerve is sensitive? Does that fit with your assessment. Are they all as bad as each other? If there is no change after c/s treatment, then mobilise his thoracic (Cv/Ct joints). Then note if it is worse. Don't mobilise the thoracic first though. I did this last year and fixed this guys symptoms, only to have them return just as bad very shortly after. X-rays etc. revealed it was his C/S. I got fooled becau!
se the c/S was referring into his T/s and down his arm simultaneously. Now I have only done his c/s and he has improved out of sight.
Also, don't mobilise his nerve, but try this glide I came up with. Find the most irritable one, put it on tension in ULTT. Then hold it there and apply and AP glide to the HOH. This should ease his pain. Repeat this for 1 min if it does. Then reassess and you should immediately get an improvement.
I have rarely seen a tendonitis that causes P+N in the hand. I had a similar guy before christmas and the previous physio had worked on his elbow etc. for severe arm and elbow pain. When I listened to his Hx and Ax him, he appeared to have subluxed his shoulder. I rang a surgeon to try and get his Ax before christmas (he had bad anterior sh pain and I was concerned about his labrum) and he said it was probably just an irritation to the calcific tendonitis that was sitting there (he was a roof tiler so it was likely he could have this incidentally). Anyway, over christmas guess what - he pops his shoulder out again. I love it when I'm right!!
doctors tend to hold on to their diagnoses for dear life!! Anyway, you can order cervical and thoracic x-rays. why don't you? Sure you can't look at a CT but at least you will get some idea of the state of his C/S.
Keep in touch.
---
Scott Epsley
PHYSIOTHERAPIST
Northside Sports Injury Centre
Brisbane, Australia.
e-mail: [log in to unmask]
On Wed, 21 Feb 2001 21:56:10
Henry Tsao wrote:
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