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Published Date : 01:43PM 19 Sep 2007
Case Study - A Ridiculous Radiculopathy
Mr C is a 41-year-old business development manager who presented with a 1-week history of left shoulder blade and posterior arm pain that extended into the lateral elbow and forearm down to the hand and also tingling in the lateral three digits. The pain had started insidiously and had worsened after a cold night at the football.
Mr C did not recall any precipitating factors, but did volunteer that he had been lifting 20kg bags at work a few days before the onset of the pain.
The pain was constant and made worse by depression of the shoulder, carrying shopping bags and left cervical rotation. He was also having difficulty working and sitting. Mr C reported that raising the arm above the shoulder relieved the pain to some extent.
Initial examination of the neck revealed a restriction in left rotation and left lateral flexion, both reproducing arm pain. Neurological examination revealed a reduction in power at the C7 myotome and a loss of C7 reflex. No obvious palpatory signs were found except for hypomobility of the C6/7 transverse process and a tight band in the scalene muscles around this level.
Mr C was educated as to the source and nature of his symptoms. He was advised that his condition was likely to be a C7 radiculopathy or 'pinched' nerve that was referring pain down the arm, much like sciatica is leg pain from nerve irritation in the lower back.
This is a common presentation of a clinical pattern that physiotherapists often see and treat effectively. Mr C was advised that his condition would take approximately 6 weeks to settle with the correct treatment. This treatment would involve a combination of anti-inflammatory medication, cervical traction, joint and soft tissue mobilising of the cervical and thoracic spines, dry needling and strengthening exercises for the neck.
Mr C was discharged 6 weeks after treatment began and was painfree and back to work full-time. A CT scan performed during the course of treatment revealed bilateral foraminal stenosis at C7 apart from other mild degenerative changes. It was suspected that a combination of heavy lifting and cold draughts increased cervical loads to cause irritation of the C7 nerve root in a compromised intervertebral foramen.
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