Clinical Chiropractic Special Interest Group – ECU Convention workshop
How would you manage the case below if it presented to your clinic?
Stein a 32 year old dental technician presents with pain to his lower neck, lateral and posterior left forearm and into his thumb and first two fingers. This came on three weeks ago for no obvious reason becoming severe over the first two days and has been there most of the time since. It is worse with prolonged sitting and can wake him when he turns at night. He has been taking Ibuprofen and a codine/paracetamol to try to help the pain but his symptoms are still marked.
He is otherwise well with good appetite and constant weight, BMI 23, before this pain started he was attending a gym twice a week. Smokes 10 cigarettes a day.
On examination: neck motions (side bending / rotation) are restricted by 20% to the left by neck pain. Spurlings test to the left causes increase in lower arm and hand symptoms. Tendon reflex to left biceps is +1, reduced light touch sensation to lateral forearm and thumb. Other tests of power, sensation and reflex (including Hoffman’s) are unremarkable. On palpation tenderness and restriction is felt over the articulations of C5/6, C6/7 and C7/T1 on the left.