This document contains a physiotherapy assessment and treatment plan for a 62-year-old female presenting with neck pain radiating to her arm. The assessment revealed reduced cervical range of motion, tenderness over the cervical spine, and positive orthopedic tests indicating nerve root compression. X-rays showed reduced disc spaces and osteophytes. The treatment plan includes shortwave diathermy, cervical traction, soft tissue techniques, range of motion exercises, and strengthening to reduce pain and muscle tightness, improve range of motion, and restore normal function. Progress will be measured by pain scale and improved cervical range of motion.

1. UCP/AL/11/221
E.K SANDAMALI
Allied Health Sciences Unit
Faculty of Medicine
University of Colombo
[Musculoskeletal Module]

2.  SUBJECTIVE EXAMINATION
 Name: Mrs. Indrani
 Age: 62 years
 Occupation: Dancing Teacher
 Present Complain: Neck Pain (Numeric Pain Scale- 5)
 Onset: Gradual onset, Before 6 months
 Pain location: R/S of neck
 Pain Type: Aching Pain
 Pain Radiating or localized: Radiating through arm, forearm,
ring and little finger
 24h behavior of pain: pain is more at night

3.  Sensation: Parasthesia over medial forearm, No vertigo or tinnitis,
 Easing factors: lying position
 Aggravating factors: Neck Extension and lateral flexion to same side
of pain
 SIN factors: She can sustain positions, and pain reduced
immediately after aggravating movements
 Function: No pain in swallowing
Past medical history: No Diabetes, HTN, Cholesterol
Past surgical history: No
X - Ray – Intervertebral Disk space has reduced.
Osteophytes over C5, C7, T1 vertebral bodies

4.  OBJECTIVE EXAMINATION
 Observation
Anterior : Unequal shoulder level – R/S shoulder is elevated
Lateral : Cervical lordosis has reduced
Shoulders are slightly protracted
Head thrust slightly forward
Posterior : Scapulae are slightly abducted

5.  Palpation
 Tenderness over C6, C7, T1 spinous processes.
 Tenderness over C7-T1 and T1-T2 facet joints
Tenderness over R/S cervical paravertibral muscles.
 Jump sign is positive.
• Trigger points on upper trapuzius muscle.

6.  Test
 Cervical quadrant test (VBI Test) - Negative
 AROM - (Tape measurement) Normal
• Cervical flexion - 9cm 9cm
• Extension - 7cm (limited and painful) 9cm
• lateral flexion - R/S- 3cm (limited and painful) 5cm
L/S- 3cm (limited and painful) 5cm
• Rotation - R/S- 5cm (limited and painful) 9cm
L/S- 5cm (limited and painful) 9cm
• Checked Shoulder flexion. Extension, Abduction, Adduction, Medial
rotation and Lateral rotation (Normal)
• PROM is also limited because of pain

7.  O’Donoghue’s Maneuver
 Compression Test – Positive
• Radiating through R/S arm, forearm and ring and little finger
 Jackson Compression Test – Positive
• R/S - Radiating pain through arm, forearm and ring and little finger
• L/S - Negative
 Flexion Extension compression Test – Positive
• Flexion – No pain
• Extension – Radiating pain
 Adson’s test - Negative
• Lateral flexion, Extension and rotation caused radiating
pain (Muscle strength grading – Grade 4)

8.  Physiotherapy diagnosis
 Condition - Cervical spondilosis
• Radiating pain mainly C8,T1 area.
• Paresthesia over C8 area.
• Cervical extension, lateral flexion and
rotation are affected and limit the ROM
 Pain radiates because R/S nerve root compression because of
osteophytes and narrowing of intervertebral foramen.

9.  Plan of treatment
Short term goals - Pain relief
Reduce muscle tightness
Restore ROM
Muscle strengthening
Long term goals - Restore normal functional level
Improve quality of life
 Pain relief – Shortwave diathermy, 15min, 2 times per week, continues mode
Radiating pain – Cervical traction (intermittent)
 Reduce muscle tightness – Kneading on upper trapezius muscle
Static friction to release trigger points
 Restore ROM – Active range of motion of cervical region
 Muscle strengthening – Isometric strengthening, 10 repetitions & 2 sets per day

10.  Justification of the plan of treatment
 Shortwave diathermy – To increase blood supply and remove
waste products
 Cervical traction – To widen the intervertebral foramina &
reduce pressure on nerve roots
 Kneading - To break the adhesion
 Static friction - To release trigger points
Active range of motion – To improve the range of limited
movements
Muscle strengthening – Increase strength of the muscle to
reduce load on cervical joints

11.  Outcome measurement of the
intervensions (Progression)
 Pain - Numeric Pain Scale - 4
ROM of cervical movements – Tape measurement (Measure the
improvement)
• Extension - 7.5cm
•Lateral Flexion L/S & R/S - 3.5 cm
• Rotation L/S & R/S - 5.5cm