Re: Cervical/scapular pain

[Guest guest]

Stanley Paris offers continuing education courses through the University of

St. Augustine on the spine. S1, S2, and S3 should help you out.

The website is www.usa.edu

Jill Piazza, PT, MSPT

Cervical/scapular pain

> I've been seeing a number of pts lately who have similar complaints --

> Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

> approaching this w/ cervical and scapular mobilization and stabilization

but am

> looking for any new ideas. I've begun to look more closely at the

thoracic

> region, possibly a subluxation at the costovertebral joint. Just

wondering if

> anyone has had much experience w/ this and what the best approach might

be.

>

> Considering this, I'd like to begin studying up on the cervical/thoracic

> region w/ regard to examination and manual treatment. Can anyone

recommend any

> good books ( " Nags and Snags " has been recommended already -- is this my

best

> resource?)

>

> Thanks,

> Voelz MA, DPT

> Peak Physical Therapy, LLC

> Madison, WI

>

>

>

[Guest guest]

There are several things to consider when evaluating someone with cervical

and unilateral medial scapular pain w/out UE symptoms. But ulitmately, if

you complete a thorough subjective and objective evaluation, you should have

a very good idea about what's going on before you even touch the patient, or

start them on any ill-advised exercise regime. You need to find out what

aggravates the symptoms and what eases them and look for a mechanical

explanation.

Another thought... the medial scapula spot of pain may represent a " Cloward

spot " and be indicative of disc pathology in the C spine. You can read up on

Cloward spots in Maitland's vertebral Manipulation.

If you think it's a thoracic problem then it should be reproducable by

thoracic spine motion or at least my mobilization to the significant

thoracic level. A manipulative technique may well be worthwhile. In the end,

you just need to use your clinical reasoning skills.

Feel free to email me off list about this case. I'd love to help you sort it

out if possible.

Louie Puentedura, PT, GDMT, OCS

S.W. Rehabilitation

Yuma, AZ

Cervical/scapular pain

> I've been seeing a number of pts lately who have similar complaints --

> Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

> approaching this w/ cervical and scapular mobilization and stabilization

but am

> looking for any new ideas. I've begun to look more closely at the

thoracic

> region, possibly a subluxation at the costovertebral joint. Just

wondering if

> anyone has had much experience w/ this and what the best approach might

be.

>

> Considering this, I'd like to begin studying up on the cervical/thoracic

> region w/ regard to examination and manual treatment. Can anyone

recommend any

> good books ( " Nags and Snags " has been recommended already -- is this my

best

> resource?)

>

> Thanks,

> Voelz MA, DPT

> Peak Physical Therapy, LLC

> Madison, WI

>

>

>

[Guest guest]

I more often then not can reproduce this pain with special tests in the

cervical region and treat it very effectively with cervical traction.

Kathi Lee MS, PT

Carson City MI

[Guest guest]

In my experience, these symptoms can often be triggered by dorsal scapular

nerve " entrapment " via the scalene complex. Scalene stretching and if

necessary, first rib mobs have been successful adjuncts to treating these

issues.

McMullen, MPT

Manager PT/OT

Rockdale Medical Center

Conyers, GA

Cervical/scapular pain

I've been seeing a number of pts lately who have similar complaints --

Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

approaching this w/ cervical and scapular mobilization and stabilization

but am

looking for any new ideas. I've begun to look more closely at the thoracic

region, possibly a subluxation at the costovertebral joint. Just wondering

if

anyone has had much experience w/ this and what the best approach might be.

Considering this, I'd like to begin studying up on the cervical/thoracic

region w/ regard to examination and manual treatment. Can anyone recommend

any

good books ( " Nags and Snags " has been recommended already -- is this my best

resource?)

Thanks,

Voelz MA, DPT

Peak Physical Therapy, LLC

Madison, WI

[Guest guest]

Kathi:

Please take the following as an inquiry from a peer reviewer, which might be

instructional for us all.

-Could you please give an example to us of what you treating with cervical

traction?

-What is a diagnosis that this intervention is addressing, and how do you

assess the outcome of this intervention?

-Are you really using this modality for treatment, or as an evaluative tool?

Ken Mailly, PT

Mailly & Inglett Consulting, LLC

Tel. 973 692-0033

Fax 973 633-9557

68 Seneca Trail

Wayne, NJ, 07470

www.NJPTAid.biz

Bridging the Gap!

Re: Cervical/scapular pain

I more often then not can reproduce this pain with special tests in the

cervical region and treat it very effectively with cervical traction.

Kathi Lee MS, PT

Carson City MI

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and participate now!

[Guest guest]

After years spent focusing on the joint biomechanics and muscular strength

of patients with such a problem I turned my attention to the more recent

research on neurodynamics and the possible contributions of abnormal

functioning in this tissue. It explains a great deal more about the nature

of such a syndrome and offers a strategy for recovery with active movement

I'd not previously considered. Look into 's text " The Sensitive

Nervous System " for starters.

Barrett L. Dorko, P.T.

<http://barrettdorko.com>

And <http://rehabedge.com>

At 09:29 PM 8/25/2004, you wrote:

>I've been seeing a number of pts lately who have similar complaints --

>Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

>approaching this w/ cervical and scapular mobilization and stabilization

>but am

>looking for any new ideas. I've begun to look more closely at the thoracic

>region, possibly a subluxation at the costovertebral joint. Just

>wondering if

>anyone has had much experience w/ this and what the best approach might be.

>

>Considering this, I'd like to begin studying up on the cervical/thoracic

>region w/ regard to examination and manual treatment. Can anyone

>recommend any

>good books ( " Nags and Snags " has been recommended already -- is this my best

>resource?)

>

>Thanks,

> Voelz MA, DPT

>Peak Physical Therapy, LLC

>Madison, WI

>

>

>

[Guest guest]

Be sure to check pectoralis minors bilaterally and release them if tight (in

sidelying). Also check for Rib mobility in ribs 1-6 (might as well check

them all. I agree, the Paris courses are excellent as are the IPA courses.

PT Plus of Oak Creek

Oak Creek, WI

Cervical/scapular pain

> I've been seeing a number of pts lately who have similar complaints --

> Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

> approaching this w/ cervical and scapular mobilization and stabilization

but am

> looking for any new ideas. I've begun to look more closely at the

thoracic

> region, possibly a subluxation at the costovertebral joint. Just

wondering if

> anyone has had much experience w/ this and what the best approach might

be.

>

> Considering this, I'd like to begin studying up on the cervical/thoracic

> region w/ regard to examination and manual treatment. Can anyone

recommend any

> good books ( " Nags and Snags " has been recommended already -- is this my

best

> resource?)

>

> Thanks,

> Voelz MA, DPT

> Peak Physical Therapy, LLC

> Madison, WI

>

>

>

[Guest guest]

We have a fairly high volume of pts. with similar symptoms and quite often

the cause is from the thoracic facets. Michigan State University's

continuing ed dept. has a great week long course in manual medicine through

their Osteopathic college. The 2 books we were given are " Principles of

Manual Medicine " by Philip Greenman and " Spinal Manipulation " by J.F.

Bourdillon, E.A. Day, and M.R. Bookhout.

Amy

BIAPT

Cervical/scapular pain

> I've been seeing a number of pts lately who have similar complaints --

> Cervical and unilateral medial scapular pain w/o UE symptoms. I've been

> approaching this w/ cervical and scapular mobilization and stabilization

but am

> looking for any new ideas. I've begun to look more closely at the

thoracic

> region, possibly a subluxation at the costovertebral joint. Just

wondering if

> anyone has had much experience w/ this and what the best approach might

be.

>

> Considering this, I'd like to begin studying up on the cervical/thoracic

> region w/ regard to examination and manual treatment. Can anyone

recommend any

> good books ( " Nags and Snags " has been recommended already -- is this my

best

> resource?)

>

> Thanks,

> Voelz MA, DPT

> Peak Physical Therapy, LLC

> Madison, WI

>

>

>

[Guest guest]

Good question Ken, but no I don't use traction as a diagnostic tool. I

find this medial scapular pain can be releaved and provoked with cervical

compression and distraction test and facet gliding, my theory being

impingment of the dorsal scapular nerve at the cervical level. I have

excellent results with cervical traction usually only needing one to three

treatments. Thanks kathi lee Carson City MI

[Guest guest]

Louie wrote

> There are several things to consider when evaluating someone with cervical

> and unilateral medial scapular pain w/out UE symptoms. But ulitmately, if

> you complete a thorough subjective and objective evaluation, you should have

> a very good idea about what's going on before you even touch the patient, or

> start them on any ill-advised exercise regime. You need to find out what

> aggravates the symptoms and what eases them and look for a mechanical

> explanation.

>

> Another thought... the medial scapula spot of pain may represent a " Cloward

> spot " and be indicative of disc pathology in the C spine. You can read up on

> Cloward spots in Maitland's vertebral Manipulation.

>

> If you think it's a thoracic problem then it should be reproducable by

> thoracic spine motion or at least my mobilization to the significant

> thoracic level. A manipulative technique may well be worthwhile. In the end,

> you just need to use your clinical reasoning skills.

>

> Feel free to email me off list about this case. I'd love to help you sort it

> out if possible.

>

I also tend to shy away from one size fits all answers, or *one*

philosophy since one persons stretch could be another persons

nerve root irritation, etc.

Probably the only thing I would add to Louie is how important it is to

coordinate our care with other medical professionals. Working in

a military setting where I had access to the radiologist test results

gave me some insight into the fact that client reports are often

lacking and how much data can be missing even from MD referrals

when one doesn't have reports, films etc. They may be critical

to a differential dx in at least a few of the cases you are seeing.

Dee Daley, PT

Southern Pines, NC