Your patient is a 35-year-old computer programmer who is referred to you because of pain symptoms in the right cervical, posterior shoulder, and arm regions. The symptoms get progressively worse when at work; usually the pain begins within 1 hour, and it is 6/10 by lunchtime. The same cycle occurs in the afternoon. There is occasional “tingling” in the thumb and index finger. The symptoms have progressively worsened over the last 3 months, ever since being placed in a priority job. Recreational activities include tennis and reading; the tennis does not cause symptoms, but reading makes the neck pain worse.

Examination reveals forward head and round shoulder posture. Capital flexion 50% range, cervical rotation and side bending are each 80% range, shoulder external rotation is 75°. There is restricted flexibility in the pectoralis major, pectoralis minor, levator scapulae, and scalene muscles. Cervical quadrant test reproduces the tingling in the right hand; all other neurological tests are negative. Strength of the suprahyoid and infrahyoid muscles, scapular retractors, and shoulder lateral rotators is 4/5.

■ What is provoking the patient’s symptoms and signs? What are the functional limitations? What is the prognosis?

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â–  Identify impairment and functional outcome goals.

â–  Establish a program of intervention. How can you progress this person to functional independence?

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