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    Case 1

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    The document provides a management plan for a patient presenting with acute, constant, severe left C4/5 cervical facet joint sprain/strain. The plan includes cervical manipulation, mobilization, supervised exercises and tissue sparing treatments over 8 weeks. Outcomes will be measured using the Neck Pain and Disability Scale at initial presentation and week 6. Manipulation and mobilization are effective treatments that may provide better pain relief and functional improvement than medications. The patient's treatment will follow this plan to address their symptoms and progress rehabilitation.

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    Case 1

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    api-510596962
    62 views3 pages
    The document provides a management plan for a patient presenting with acute, constant, severe left C4/5 cervical facet joint sprain/strain. The plan includes cervical manipulation, mobilization, supervised exercises and tissue sparing treatments over 8 weeks. Outcomes will be measured using the Neck Pain and Disability Scale at initial presentation and week 6. Manipulation and mobilization are effective treatments that may provide better pain relief and functional improvement than medications. The patient's treatment will follow this plan to address their symptoms and progress rehabilitation.

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    The document provides a management plan for a patient presenting with acute, constant, severe left C4/5 cervical facet joint sprain/strain. The plan includes cervical manipulation, mobilization, supervised exercises and tissue sparing treatments over 8 weeks. Outcomes will be measured using the Neck Pain and Disability Scale at initial presentation and week 6. Manipulation and mobilization are effective treatments that may provide better pain relief and functional improvement than medications. The patient's treatment will follow this plan to address their symptoms and progress rehabilitation.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    62 views3 pages

    Case 1

    Uploaded by

    api-510596962
    The document provides a management plan for a patient presenting with acute, constant, severe left C4/5 cervical facet joint sprain/strain. The plan includes cervical manipulation, mobilization, supervised exercises and tissue sparing treatments over 8 weeks. Outcomes will be measured using the Neck Pain and Disability Scale at initial presentation and week 6. Manipulation and mobilization are effective treatments that may provide better pain relief and functional improvement than medications. The patient's treatment will follow this plan to address their symptoms and progress rehabilitation.

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    Week 3 category 1

    Activity 1:
     Acute constant severe left C4/5 cervical facet joint sprain/ strain
     Acute constant grade 2left supraspinatus strain

    Activity 2:
    Management plan for acute constant severe left C4/5 cervical facet joint sprain/ strain

    Manipulation, mobilisation, supervised exercises and tissue sparing are effective treatments for non-traumatic
    neck injuries1. The Cochrane review of manipulation and mobilisation for neck pain contrasted against and
    inactive control or another active treatment2 concludes that ‘multiple cervical manipulation sessions may
    provide better pain relief and functional improvement than certain medications at
    immediate/intermediate/long-term follow-up’.

    The patient presented within hours of onset with constant sharp shooting pain from her neck to her left upper
    arm. These symptoms are consistent with a facet sprain at C4/5. The patient’s treatment will include HVLA
    adjustments, soft tissue work on the surrounding musculature as well as rehabilitation including tissue sparing
    and prescribed exercises for the region. The Neck pain and disability scale (NPAD) PROM will be utilised during
    the first appointment, and then again in week 6 to assess patient progress.

    Treatment Rehabilitation Progression PROMs/ homework


    Week 0-2 Cervical mobilization. Tissue sparing 2 visits/ week Neck pain and disability
    ROM assessment to create a scale (NPAD)
    baseline. encourage patient
    Soft tissue therapies to alleviate activity such as walking
    muscle guarding
    HVLA cervical adjustments from
    second appointment

    Weeks 2-4 HVLA adjustments. Cervical Tissue sparing, start to 1 visit/ week Get patient active and
    mobilization increase ROM and discuss ADLs
    Soft tissue therapies strength

    Weeks 4-6 HVLA adjustments. Cervical Assess patient recovery 1 visit/ week Maintain patient activity
    mobilization and prescribe rehab and return to modified
    Soft tissue therapies exercises accordingly ADLs

    Weeks 6-8 HVLA adjustments. Cervical Resisted exercises 1 visit/ fortnight Complete NPAD
    mobilization Continue modified ADLs
    Soft tissue therapies
    References

    1. The Institute for Work & Health, neck pain evidence summary, the Institute for Work & Health, 2010

    2. Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C,
    Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F.
    Manipulation and mobilisation for neck pain contrasted against an inactive control or another active
    treatment.
    Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004249.

    Case 1: Category 2 (serious MSK)

     DDx: 
    Acute, moderate-severe, constant, left, shoulder, impingement (partial supraspinatus) 
    Acute, moderate-severe, constant, C4/5, lateral disc lesion 
    Acute, moderate-severe, constant, left, shoulder, SLAP tear

    Appropriate Examination:

    1. Gait & Inspection


    2. AROM of the shoulder
    3. Static palpation must be appropriate and diagnostic. 
    o Complete bilaterally starting with the non-painful arm o G/H joint o Acromion / clavicle o
    SITS muscles and tendons o Long head of the biceps & Bicipital groove o Shoulder girdle –
    Scapula & A/C Joint.
     PROM / Motion Palpation (MP)
     Special Tests
     Empty Can (supraspinatus)
     Neers (subacromial impingement) 
     Hawkins Kennedy (subacromial impingement)
     O’Briens (SLAP)
     Spurling  (nerve root)

    DDX: Acute Myocardial infarction,

    Activity 1:
    A) Possible Tumour,
    B) Sudden onset, heavy smoker, increasing fatigue,
    C) Clear incident to cause pain,
    D) Risk factors: smoking, increasing fatigue,

    Activity 2:
    A) Ramipril, reduced blood pressure or blood vessels, ACE inhibitor
    B) Ibuprofen, anti-inflammation medicine,
    C) 1 Diuretics – help kidneys eliminate waste
    2 calcium channel blockers – block entry of calcium into muscle cells
    3 ACE inhibitors – inhibit the activity of angiotensin-converting enzyme
    4 Angiotensin II – antagonizing the activation of angiotensin receptors
    5 Adrenergic receptor antagonists – beta blockers
    6 Vasodilators – act directly on the smooth muscles,
    D) Nausea, heartburn, loss of appetite, changes in mood, sleeplessness
    E) Non steroid anti-inflammatory drugs – nurofen
    Activity 3: Results insignificant

    Activity 4: MRI,
    - Patient suspected Myocardial infarction,
    MRI of Chest to detect myocardial oedema,

    Act 5:
    Name Rationale Summary Significance Next step
    ECG Testing for Results normal No myocardial Go to next ddx
    myocardial infarction
    infarction

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