Your patient is a 35-year-old computer programmer who is referred to you because of pain symptoms in

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
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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.

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

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Identify impairment and functional outcome goals.

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

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