Upper Limb Tention and counting money (Full Version)

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VagusX -> Upper Limb Tention and counting money (May 26, 2003 6:21:00 PM)

I have a patient with severe left upper extremity radiculopathy from a cervical bone spur.

Her job requires her to count money all day long. By the end of the day her radiculopathy travels all the way to her fingers. She tells me she requires arm movement to count the money just finger motion.

My question is: Do they make a a support sling to unweight the UE and also allow free hand movement in a functional position? The position that is required to count the money is in the POS, elbow ~90 degrees and the elbow forearm in neutral. Am I on the right track? Anybody ever try unweigting the UE for this sort of problem?

Might as well ask while I'm at it. Any great techniques for treating Upper Limb tention/cervical bones spurs? Currently I do nerve mobs, cervical prom to LS/UT/scalenes/pec minor/pec major, and ant translation of the cervical vertebrae followed by side glides.

any help would be appreciated

Dan



mcap56 -> Re: Upper Limb Tention and counting money (May 27, 2003 7:24:00 AM)

Dan:

I don't know off of the top of my head. A long workday in a sling can not be a good thing even if it does unload the UE.

You are dealing with an ergonomcis issue. I would post your question to ergoweb.

wwww.ergoweb.com

They have a discussion list-serv.....

Best,
mcap



coloradojulie -> Re: Upper Limb Tention and counting money (May 27, 2003 7:21:00 PM)

I would also be very careful about mobilizing a neck with known bone spurs. Those things are unpredictable and you cannot tell with any certainty what is happening with them with your mobilization ie. nerve trauma, cerebral artery contact etc. I never use mobs on a neck with known bone spurs...also be cautious with nerve glides as they are also unpredictable with the spur and you can aggravate the patient quite easily.

I am sure her job requires more than just finger motions, and unweighting the arm may not be the answer, unless you think the upper trap is the main culprit. Instead consider the position her head is in when she counts the money. Unless the money is right at eye level she needs to look down a good portion of the day to see what she is doing. She may be holding the neck in lordosis with a forward head position creating anterior shear at C7/T1. Address her head posture and the ergonomics of her job station (as far as where the money is, can she sit and count to be closer to the money, can she raise the platform.) With this kind of posture cervical extensors are shortened and the facets are loaded in the neck, causing inflammation etc. Increase her true cervical flexion mobility, release SCMs, and strengthen deep neck flexors.

Suggest she consider a new job if her symptoms are severe...the more her nerves are compressed the more at risk she is for permanent dammage.



PTupdate.com -> Re: Upper Limb Tention and counting money (May 28, 2003 5:13:00 AM)

I am not so sure a sling all day is the best option either. As mcap indicates, the ergonomic considerations should be dealth with by an expert in that field.

Compared to Julie, I have no problem performing cervical mobilization on patients with spur formation. The degree of spur formatino may dictate, to some degree, what is performed and to what degree.

A typical patient with endplate spurring, doing normal daily cervical ROM to drive, look up at airplanes, etc. is placing biomechanical forces through these regions which are probably not surpassed by mobilization (manipulation yes).

Monitoring symptoms and beginning the program with low forces allows the PT to monitor how the patient will adjust. I do this on a routine basis and have never had a significant flare-up, but have had great results. Some advocate a "no mobilization" policy to degenerative joints, but I don't.

In fact, I have a good degree of endplate spurring and foramenal encroachment at my own C6-7 level, with a small HNP also butting in. Aggressive Mulligan style mobilizions with a McKenzie twist pulled me out of the hole.

John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



McKPT -> Re: Upper Limb Tention and counting money (May 30, 2003 1:29:00 PM)

Where is the bone spur? Is it in the central canal or foramina? And what position is her head/neck in while she is counting the money?
I am assuming she is in a flexed position. So in this position the foramina and canal are widened thus creating more space for the spur and nerve root. Yet she experiences a peripheralization of her symptoms while in this posture. Could it be possible she has an active cervical derangement that worsens with sustained flexion and the bone spur just happens to be there but not the actual cause of her problem.



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