Case A

A 47-year-old man comes to you complaining of elbow and neck pain. There is no
recent history of trauma, but he remembers being in a motor vehicle accident 19 years
ago. He now works at a desk all day. Describe your assessment of this patient.

Questions:

1. What is the ROM affect the patient? Create a theoretical one.

Motion

Neck flexion 0-20°

Neck extension 0-45°

Neck lateral flexion 0-30°

Neck rotation 0-50°

Elbow flexion 0-130°

Elbow extension 0- 20°

Forearm pronation 0-65°

Forearm supination 0-65°

Shoulder flexion 0-175°

Shoulder extension 0-55°

Shoulder internal rotation 0-55°

Shoulder external rotation 0-75°

Shoulder abduction 0-175°

Shoulder adduction 0-10°

Px ROM is far from the N value d/t pain acquired during each motion, and ↓ ROM on UE.
2. What are the expected muscles affected in the case. List it down.

-brachialis

-brachioradialis

-pronator teres

-deltoid

-biceps brachii

-triceps brachii

-Levator scapulae

-Sternocleidomastoid

-Trapezius

-Erector spinae

-Suboccipitals

3. What is your initial diagnosis of the patient?

- Px was dx c cervical spondylosis as well as elbow radicular pain. Px is already

47 years old and vulnerable to this disease. Furthermore, the patient spends at
least 12 hours per day at a desk. His poor working posture contributes
significantly to his cervical spondylosis. He could be putting his neck in an
uncomfortable position. Finally, it could be linked to the car accident he was in 19
years ago, as neck trauma is a risk factor for cervical spondylosis.

4. What are your provocative tests to be used in the patient?

- FORAMINAL COMPRESSION TEST

Position Procedure (+) Significance

Sitting First Phase: Pain radiates Cervical Nerve

compress with toward which the Root
head in a neutral head is side Compression
position. Second flexed during
Phase: compress compression
with head
extended Third
Phase:
compression with
 head extended
and rotated to the
unaffected

5. What is the top 3 problems of the patient?

● Sharp, shooting pain on the neck c PS 7/10 (0 - no pain, 10 - worst pain) that radiates
on that radiates into the shoulder and/or arm, as well as muscle weakness and
numbness.
● mm weakness on UE
● Difficulty in performing ADLs
6. Based on the exercises and modalities learned, what is your initial treatment for the patient?
List it down with its rationale.
- cervical traction x 20 mins x per session. to alleviate the nerve root compression
- Calliet exercise on B neck towards AP x 15sh x 10 reps x 1sets
● Giving cervical retraction, cervical extension, and deep cervical flexion
exercises isometric flexion and scapular strengthening, as well as chest
muscle stretching Flexor and extensor muscle contraction to improve
upper extremity neural structure mobility

Case B

A 27-year-old patient complains of radicular signs such as tingling sensation, and sharp
and shooting pain c PS 5/10 on his low back the moment he went to the clinic p
hyperflexion injury of the thoracolumbar spine that happened during the car collision
three days PTIE. You were directed as the PT.

Other findings:

• Patient having difficulty turning the trunk to the right and when looking down to the
floor

• Tingling sensation arises from the back of the lower head to the shoulder area (both)

Describe your assessment of this patient.

Questions:
1. What is the ROM affect the patient? Create a theoretical one.

MOTION

0-12°
Cervical flexion

0-8°
Thoracolumbar lateral flexion

15 cm
Thoracolumbar flexion

- Px. has ↓ ROM Cervical flexion, Thoracolumbar lateral flexion and Thoracolumbar
flexion d/t sharp and shooting pain c PS 5/10 on his low back

2. What are the expected muscles affected in the case. List it down.

● Scalene mm.
● Deep cervical flexors mm. (longus capitus mm. and longus colli mm.)
● SCM
● Rectus Abdominis
● Erector Spinae
● External and Internal Obliques
● Latissimus dorsi
● Deep Posterior Spinal mm

3. What is your initial diagnosis of the patient?

lumbar disk herniation with radiculopathy

- Px's initial diagnosis is cervical sprain because the provocative sign was pain in
the lower back and the px having difficulty turning the trunk to the (R) and when
looking down to the floor and Tingling sensation arises from the back of the lower
head to the shoulder area.
4. What are your provocative tests to be used in the patient?

Slump test

These tests will test a neural tension test used to detect altered neurodynamics or
neural tissue sensitivity.

5. What is the top 3 problems of the patient?

- (+) pain on low back

- (+) paresthesia
- ↓ ROM on Cervical flexion, Thoracolumbar lateral flexion and Thoracolumbar flexion
-

6. Based on the exercises and modalities learned, what is your initial treatment for the
patient? List it down with its rationale.

- McKenzie Exercise 1-3 (Prone, Prone c elbows, and Prone c extended arms) x 6
sec hold x 10 reps x 1 set
- klapps exercise 1-3 (Prone, Prone c elbows, Prone c extended arms and c
lateral movement) x 6 sec hold x 10 reps x 1 set

Case C

A 14-year-old girl comes to you complaining of neck pain. She has long hair. She states
that when she “whipped” her hair out of her eyes, which she has done many times
before, she felt a sudden pain in her neck. Although the pain intensity has decreased, it
is still there, and she cannot fully move her neck. Describe your assessment plan for
this patient.

Questions:
1. What is the ROM affect the patient? Create a theoretical one.

MOTION

CERVICAL FLEXION 0-16°

CERVICAL EXTENSION 0-18°

CERVICAL LATERAL FLEXION 0-10°

CERVICAL ROTATION 0-26°

Ratio:Px ROM is far from the N value d/t pain acquired during each motion, and she
cannot fully move her neck away from the indicative value.

2. What are the expected muscles affected in the case. List it down.

- Sternocleidomastoid
- Scalenes
- Deep cervical flexors mm
- Trapezius (all 3 portion)

Ratio: The indicative mm. affects all cervical motions, preventing the px from performing
its pain function.

3. What is your initial diagnosis of the patient?

- CERVICAL SPRAIN
● Since the only provocative sign was pain, the px's initial diagnosis is
cervical sprain. Also on the c/c of the px is neck pain whenever she whips
her long hair out of her eyesight. It could be due to an improper sleeping
position or poor posture, which causes difficulty moving her head and
neck in all directions.

4. What are your provocative tests to be used in the patient?

- FORAMINAL COMPRESSION TEST

Position Procedure (+) Significance

Sitting First Phase: Pain radiates Cervical Nerve

compress with toward which the Root
head in a neutral head is side Compression
 position. Second flexed during
Phase: compress compression
with head
extended Third
Phase:
compression with
head extended
and rotated to the
unaffected

When performed, these tests will reveal cervical nn, root compression, and a negative
sign of radiating pain. This will also assist the PT in determining how to treat the px.

5. What is the top 3 problems of the patient?

- (+) pain on cervical region(laterally and specific part was not indicated)
- ↓ ROM on cervical region in all motion
- Difficulty in performing ADLs such as whipping hair away from the eyesight

6. Based on the exercises and modalities learned, what is your initial treatment for the
patient? List it down with its rationale.

Exercises:

● Calliet exercise on B neck towards AP x 15sh x 10 reps x 1sets

● Chin tuck in supine position c rolled towel underneath the neck x 6 sec hold x 10
reps x 3 sets to strengthen deep cervical flexor mm and scalene mm.