Presentation:
42 y/o female nurse presents with a two-week history of central and sharp upper cervical pain and stiffness with associated headache resulting in increased tone of the bilateral upper trapezius muscles.
Pain is greater on the right-hand side.
The patient also experiences intermittent double vision.
She has referred pain from the base of her skull up to the top of the head.
In addition, she has experienced sinus symptoms with pain under the eyes and between the eyebrows. Not uncommon for her. She denies any prior history of neck pain, any history of motor vehicle accidents, and any trauma to the head or neck.
Examination:
Cervical Range of Motion; Right Rotation: 73 deg, Left Rotation: 58 deg, Left Lateral Flexion: 43 deg, Right Lateral Flexion: 47 deg, Flexion: 60 deg, & Extension: 55 deg.
Cervical Facet Compression (Kemps); Right: Positive, Left: Negative
Cough/Sneeze/Valsalva; Negative
Neurological Examination; Unremarkable. No radicular signs. Reflexes intact bilaterally. Muscle strength good bilaterally.
Palpation; Sensitivity & restriction of the right C2/3 and T2, T3, T7, T8.
Vascular Testing: Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Diagnosis:
Acute right C2/3 facet dysfunction and irritation associated with hypertonic bilateral upper traps, suboccipitals, and scalenes predisposed by poor habitual work postures and sleeping posture.
Treatment:
Education and advice
Trigger point therapy
Soft tissue therapy
Active releases of bilateral upper trapezius, levator scapulae, anterior scalenes, and suboccipitals
T7/8 & T2/3 extension tractional adjustment
C2 supine rotational adjustment
Seated cervical and cervicothoracic SNAGS (Facet Joint Mobilisation)
Home Exercise:
Ice therapy
Gentle neck movements into pain free ranges.
Outcome:
After 2 consultations in the first week, the patient’s range of motion increased in all movements. Patient reports neck pain and upper trapezius pain and tension to be minimal.
After 3 consultations at the end week 2, patient reported no neck pain and a further increase in cervical range of motion.
Notes:
It is quite common for patients to think they have fully recovered at this point because majority of symptoms have disappeared. However, the underlying faults within the biomechanics have not yet been corrected, so the risk of relapse or re-injury is high.
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