Case Presentation

Submittedby:-
Jobinpreet Kaur Kohli
17601035
 Demographic Data
Name :- Reshma Yadav
Age :- 26 years
Gender :- Female
Occupation :- House wife
Address :- Deep avenue, Tarn Taran
Date Of Assessment :- 25.12.19
Place of Assessment :- Guru Nanak
Hospital, Tarn Taran
Chief complaint
•Pain in neck and shoulder * 2 years
•Numbness in the right arm and hand *
2 years
•Difficulty in doing overhead activities
•Weakness in the right hand and arm
Present history of illness
The patient was well before December 2018.
After that she started experiencing pain in her
neck and shoulder region. She took analgesics
but the pain did not subside. Her pain got more
worse and then she went to Guru Nanak hospital
for her treatment.
• Past history of illness :- Patient was having pain in neck and
shoulder region along with a feeling of numbness in right
arm and hand * 2 years
• Present surgical history :- Not present
• Past surgical history :- Not present
• Medical history :- N/K/C/O – HTN, DM
• Drug history :- Analgesics
• Personal history :- Marital status – Married
Socio economic status – Middle class
 Pain History
• Side :- Right
• Site :- posterior (neck region), right arm (medial
aspect)
• Type :- Sharp
• Onset :- Gradual
• NPRS :- On Activity -6/10
At rest – 2/10
•Aggravating factor :- During overhead
activities and heavyweight lifting.
•Relieving factor :- Analgesics
Body chart
 On Observation
• Built :- Endomorphic
Weight :- 60 kg
Height :- 5 feet
BMI:-25.8 kg/m²
• Posture :-Forward head posture
Joint Right of limb
Attitude Left
Shoulder Slight adduction and Slight adduction and
internal rotation internal rotation
Elbow Extension Extension
Wrist Neutral Neutral
 On palpation
•Warmth :- Normal
•Tenderness :- present ( grade 2),
Over the upper trapezius and rhomboids
•Oedema :- Not present
 On Examination
Right side
• Dermatome :- Myotome:-
• C1- intact C1- intact
• C2- intact C2- intact
• C3- intact C3- intact
• C4- intact C4- intact
• C5- intact C5- intact
• C6- intact C6- intact
• C7- intact C7- intact
• C8- not intact C8- not intact
• T1- not intact T1-not intact
 Motor system Examination
• Range of motion ( Cynthia c. Norkins)

Movement Range
Cervical flexion 0-30°
Cervical extension 0-40°
Cervical side flexion To left:- 0-20⁰
To right:-0-15⁰
Cervical rotation To left :- 0-40⁰
To right :- 0-45⁰
 Movement Right ( affected) Left
Shoulder flexion 0-90⁰ 0-180°
Extension 0-40° 0-60°
Abduction 0-80⁰ 0-180°
Adduction 80°-0° 180°-0

Internal rotation 0-60° 0-70°

External rotation 0-40° 0-90⁰

Elbow Flexion 0-150° 0-150°

Extension 150°-0 150°-0
Wrist Flexion 0-80° 0-80°
Extension 0-70° 0-70°
 Muscle Power
• MMT ( Daniel and Worthington)
Muscles Power

Cervical Flexors 4

Extensors 4

4
Rotators
 Muscles Right (affected) Left

Shoulder flexors 3+ 5

Extensors 4 5

Abductors 4 5

Adductors 4 5

External rotators 3 5

Internal rotators 3 5

Elbow flexors 5 5

Extensors 5 5

Wrist flexors 4 5

Extensors 4 5
 Reflexes
•Deep reflexes ( Wexler ‘s grading)
Reflex Right Left

Biceps (C5) 2 2

Brachioradialis 2 2
(C5-C6)
Triceps(C7-C8) 1 2
 Differential Diagnosis
•Cervical spondylosis ??
•Thoracic outlet syndrome??
 Special Tests
•Bakody’s sign :- -ve
•Distaction test:- -ve
•Adson test :- +ve
•Roos test :- +ve
•Upper limb tension test ( ulnar,median
nerve) :- +ve
 INVESTIGATION
X-RAY FINDINGS : AP view reveals the presence of cervical rib on both sides
Diagnosis :- Thoracic Outlet
Syndrome ( Symptomatic
TOS)
 Physiotherapy Management
• Superficial thermotherapy. Hot pack on
posterior neck * 10-15 min
• TENS :- Frequency :- 90 – 130 Hz
Mode :- Conventional
Duration :- 15 min
• Deep massage manipulations :- Circular
kneading and frictions to localised area
• Strenghtening exercises for the levator scapulae and trapezius
mucsles.
• Stretching exercises for the tightened muscles(pectorals ans scalene
muscles)
• Correction of impared posture
• Shoulder excercises to restore the renge of motion.
• Isometric exercises for the neck muscles.
• Advice the patient to maintain correct posture at home and other
places
• Avoid lifting heavy weights on the affected side.
THANK YOU
Thank you