Acute Cervicothoracic Pain: A case study

By Dr. Jason D. Nyman, BSc (Hons Kin), DC
December 01, 2002

History

M.M. is a 39-year-old female airline service supervisor and caregiver. She presented with acute neck/shoulder pain of 3-days duration. She could not identify an event or trauma that instigated her pain. However, the onset coincided with a bought of “stomach flu or food poisoning.” This resulted in violent emesis and bed rest over the three days which seems to have lead up to the onset of her neck pain.

The pain was localized to the posterior cervical-thoracic region. She reported a “numbing” feeling radiating down her right posterior shoulder and arm to approximately elbow level. She reported the pain was progressively getting worse and she rated her pain at 8.5 on a VAS pain scale. Moving her head and neck, particularly in right rotation, aggravated her pain. Tylenol 3, deep cold application, and keeping her neck still provided some relief.

The patient’s past medical history includes hypertension, hypothyroidism and alopecia. Her medications included levothyroxine, a birth control pill, and a blood pressure pill. The patient had previously received chiropractic care during pregnancy, which included some cervical manipulation. The patient expressed apprehension regarding cervical manipulation and requested that it not be performed.

Examination

On examination, cervicothoracic active range of motion (AROM) was reduced 50% in right and left rotation, however, right rotation produced more pain. All remaining cervicothoracic AROMs were reduced less than 25% and painful. Cervicothoracic resisted ROM testing was painful in all ranges. Kemp’s test produced contralateral pain in the cervicothoracic region. Long axis distraction of the cervical spine was unremarkable. The Soto-Hall test was negative. Neurological examination of the upper extremities was unremarkable.

Static and motion palpation revealed restricted and tender joint play of the right C3 and C4 segments. Palpation revealed tender and hypertonic upper trapezius muscles and levator scapulae bilaterally. A very tender trigger point was noted in the right C3-5 posterior paraspinal muscles. Radiographic examination was deferred.

Clinical Impression

My clinical impression was acute mechanical cervicothoracic pain arising from C3-4 facet joint dysfunction with concomitant muscle spasm. A trial of Trigenics® treatments was recommended to the patient.

Treatment

• Trigenics strengthening and lengthening procedures were administered daily during the acute phase. Five treatments were delivered in the first week, followed by two treatments in the second week. Treatments were directed at myopoints identified by palpation of the involved musculature.
  Treatments consisted of the following Trigenics® Strengthening procedures:
  Levator scapula (prone) III TS
  Upper Trapezius (prone) TS
  Suboccipitals TS
  Atlanto-Occipital Extensors TS
  Posterior Paraspinal Cervicals TS
  Sternocleidomastoid TS The treatments also consisted of the following Trigenics® Lengthening procedure:
  Upper Trapezius (prone) TL
  The patient was also instructed to use ice therapy 3-4 times per day for 10-12 minutes during the acute phase.

Outcome

The patient improved rapidly with daily care. Immediately following the first treatment, the patient’s cervical rotation increased by approximately 20%. However, there was still pain at the end of her tolerated range.
By the third day, her symptoms had subjectively improved by 70%. Objectively, her pre-treatment cervicothoracic range of motion was less painful but still limited 50% in rotation bilaterally. However, her post-treatment range of motion improved to a 10% reduction in right and left rotation.
Following her seventh treatment, her VAS score was 0/10. Her cervicothoracic range of motion was full and painless in all ranges. Kemp’s test was negative bilaterally. The C3-5 cervical, posterior paraspinals displayed only mild increased resting tone, but were not painful. The cervicothoracic musculature was generally less hypertonic. Functionally, the patient was once again working, caring for her two young children, and sleeping comfortably.