Cervical Myalgia Case Study

The patient responded well to treatments for cervical myalgia. After one week scapular mobilizations were added during clinic visits, including lateral glides with distraction and external rotation with distraction. After four weeks, her cervical active ROM was normal and she reported no headaches, however she reported no change in her upper extremity symptoms. She stopped wearing wrist splints after three weeks, complaining of increased stiffness in the wrists and hands and no benefit to night pain. The patient reported that tendon gliding exercises neither provoked nor relieved hand and upper extremity symptoms. She reported greater awareness of tingling and numbness in the first four digits during the course of physical therapy, but attributed this to greater awareness and didn’t believe that her hand symptoms had changed.

The patient was referred to

While conservative treatment may offer benefit to patients with mild to moderate CTS, the majority of patients with severe median nerve compression require surgical decompression to achieve long-term curative results. Based on the severity of compression, as confirmed by nerve conduction studies, the potential of conservative interventions providing long term benefit was poor. The case is also useful as it highlights that distal neuropathy may manifest clinically with chief complaints upstream, and with minimal patient complaint of classic CTS hand symptoms. With conflicting research regarding the diagnosis and treatment efficacy of CTS, it would be very useful to have an evidence-based standardized group of tests for CTS; the results of which would provide a standardized measure of severity of the disease. Additional research may yet provide a gold standard test protocol for the clinical diagnosis of CTS, with an associated severity scale, and a standard guide for surgical and