cervical root syndrome sc4

8/13/2019 Cervical Root Syndrome Sc4

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Cervical Root Syndrome

Indah ariefani


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Data base (April 18th, 2012)

Identity

Name : Mrs. N

Sex : woman

Age : 37 years old

Address : Surabaya

Occupational : Employe PT. Sampoerna

Religion : Moslem

Ethnic : Javanese

Marital status : Married

Referred from PT.Sampoerna clinic with nyeri leher kiri


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Chief complain : nyeri leher kiri

History of present illness :

She felt pain since 11 years ago, pain was mild and only occur if tootired to work but pain was increase since 3 months ago.

Pain felt continuously, radiated from left neck to shoulder, arm andleft fingers

Tingling sensation was felt periodically, especially when she wasworking.

She felt numbness on her left upper extremity

No weakness of the upper extremity

When she was working (cutting out cigarettes on sampoernafactory), the pain was increase

Since her pain is increase (since 3 months ago) she felt her workmore slowly. (Usually once scissors, left hand can hold 6-8cigarettes at a time, but now she hold one by one

She felt worried about her disease


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History of past illness :

- No diabetes mellitus

- Hypertension (+) since 1 years ago, routin

countrol in cardiovasculer outpatient clinick

but she forget the name of medicine

- No trauma


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Physical Examination (18/04/12)

General StatusCM, independent ambulation, normal gait, right handed

Body Weight : 45 Kg, Body height : 146 cm, BMI = 21,1

BP : 120/80 mmHg, HR : 76 x/minute, RR : 20 x/minute

Head and Neck : No Anemia, Icterus, Cyanosis, Dyspneu

Thorax : Cor : S1S2 sound, murmur -, gallops -

Pulmo : vesicular/vesicular,

wheezing -/-, ronchi -/-

Abdomen : Meteorismus (-), Liver / Spleen : unpalpableExtremities : warm acral +/+, edema -/-


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Physiatric Examination

Musculoskeletal examination

Cervical ROM MMT

Flexion F (0-450) 5 (pain)

Extension F (0-450) 5 (pain)

Lateral Flexion F/F (0-450

) 5/ 5(pain)Rotation F/F (0-600) 5/ 5(pain)

Trunk ROM MMT

Flexion Full (0-80:) 5Extension Full (0-30:) 5

Lateral Flexion F/F (0-35:) 5/5

Rotation F/F (0-45:) 5/5


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Shoulder ROM MMT

Flexion F/F (0-180:) 5/5 (pain)Extension F/F (0-60:) 5/5 (pain)

Abduction F/F (0-180:) 5/5 (pain)

Adduction F/F (0-45:) 5/5 (pain)

Ext. Rot. F/F (0-70:) 5/5 (pain)Int. Rot. F/F (0-90:) 5/5 (pain)

Elbow ROM MMT

Extension-Flexion F/F (0-1350

) 5/5Forearm supination F/F (0-900) 5/5

Forearm pronation F/F (0-900) 5/5


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Wrist ROM MMT

Flexion F/F (0-800) 5/5

Extension F/F (0-700) 5/5

Radial deviation F/F (0-200) 5/5Ulnar deviation F/F (0-350) 5/5

Fingers ROM MMT

FlexionMCP F/F (0-900) 5/5

PIP F/F (0-1000) 5/5

DIP F/F (0-900) 5/5

Extension F/F (0-300

) 5/5Abduction F/F (0-200) 5/5

Adduction F/F (200-0) 5/5


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Thumb ROM MMT

Flexion

MCP F/F (0-900) 5/5

IP F/F (0-80

0

) 5/5Extension F/F (0-300) 5/5

Abduction F/F (0-700) 5/5

Adduction F/F (500-0) 5/5

Opposition - 5/5

Hip ROM MMT

Flexion F/F (0-1200) 5/5


Abduction F/F (0-450) 5/5

Adduction F/F (0-200) 5/5Ext. Rotation F/F (0-450) 5/5

Int. Rotation F/F (0-450) 5/5


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Knee ROM MMT

Extension-Flexion F/F (0-1350) 5/5

Ankle ROM MMT

Plantar Flexion F/F (0-500) 5/5

Dorsi Flexion F/F (0-200) 5/5

Inversion F/F (0-350) 5/5

Eversion F/F (0-150) 5/5

Toes ROM MMT

FlexionMTP F/F (0-300) 5/5

IP F/F (0-500) 5/5


Big Toe ROM MMT

Flexion

MTP F/F (0-250) 5/5

IP F/F (0-250) 5/5



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Neurological Examination

N. Cranialis IXII : within normal limit

Deep tendon Reflex : BPR +2/+2

TPR +2/+2

KPR +2/+2

APR +2/+2

Pathological Reflex : Babinski -/-, HT -/-


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sensory

100% C5 75%

100% C6 75%

100% C7 75%

100% C8 75%

100% T1 75%


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Locally status Regio Cervical - Shoulder:

Inspection : deformity -/-, inflamatory sign -/-,

atrophy -/-, swelling -/-

Palpation : paracervical muscles spasm +/+

uppertrapezius muscle spasm +/+,

tender point -/-


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Special test :

Head compression test : -

Head distraction test : +

spurling test : -/+

TOS I, II, III : -/-

Phallen test : -/-

Prayer test : -/-

Tinel sign : -/-


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Diagnosis :

Medical : CRS root C5,6,7,8,T1 sinistraFunctional diagnosa :

Impairment : - paracervical muscles spasm

- uppertrapezius muscle spasm

- sensory deficit in dermatom

C5,6,7,8,T1 sinistra

Disability : -

Handicap : reduced of efficiency on work


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Problem list :

1. Medical : CRS root C 5,6,7,8,T1 sinistra

2. Surgical : (-)

3. Rehabilitation Medicine:

R1 (Ambulation) : -R2 (ADL) : -

R3 (Communication) : -

R4 (Psychological) : worried about her

diseaseR5 (Social Economic) : income decreases


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R6 (Vocational) : reduced of efficiency on work

R7 ( Others ) : - pain on neck, shoulder untilfingers sinistra

- paracervical muscles spasm +/+

- uppertrapezius muscles

spasm +/+- Sensory deficit in dermatom

C 5,6,7,8, T1 sinistra

- spurling test -/+distraction test -/+

- HT terkontrol


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Planning :

1. Medical : meloxicam 1x15mg, diazepam 1x1 ,

neurotropic

2. Surgical : (-)

3. Rehabilitation Medicine :

P. Dx : foto radiologi cervical ap/lat

P. Tx : modalitas: USD area upper

trapezius 1 MHZ frequency 2x/week

OT : resensitisasi sensoris


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P.Mx : klinis, simptom : vas, defisit sensoris

P.Ex : explain abouth her disease

postur correctionneck cailliet exercise (precaution HT )

resensitisasi sensoris


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Summary

It has been reported that a women 37 years old.Referred from PT.Sampoerna clinic with nyeri leher kiri

She felt pain since 11 years ago, pain was mild and onlyoccur if too tired to work but pain was increase since 3months ago. Pain felt continuously, radiated from left neckto shoulder, arm and left fingers. Tingling sensation was feltperiodically, especially when she was working. She feltnumbness her left upper extremity. No weakness of theupper extremity. When she was working, the pain wasincrease. Since her pain is increase (since 3 months ago)

she felt her work more slowly. She felt worried about herdisease


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From physical examination was found paracervicaland upper trapezius muscles spasm, and there wassensory deficit dermatom C5,6,7,8,T1 sinistra. Positifspurling test and distraction test.

Planning diagnose was doing foto radiologyCervical AP/LAT. Planing terapi were give modalitas :area upper trapezius and OT: resensitisasi sensoris.Planning Monitoring: Clinical signs and symptoms.

Planing education: explain abouth her disease, posturcorrection, neck cailliet exercise (precaution HT ),resensitisasi sensoris.


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THANX YOU


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Definition:

Group of symptoms are occured from nerve

root entrapment/ irritation within the foramen

intervertebralis and give subjective and or

objective dermatome or myotome distribution.


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PATOGENESA

the cervical nerve root compression

symptoms of neck pain which followed spread

to the shoulders, upper arms / forearm,

paresthesia, weakness


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etiology

Inflamasion : edema can cause pressure

Trauma : bledding / blood clot

Osteofit Herniasi diskus


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Clinical Symptom:

Pain and tingling in the neck, radiated to

shoulder, pectoral, scapulae, arm and forearm

on the affected side.

Sensoric symptom : parestesia and

hipoestesia.

Weakness in the neck muscle, arm and

forearm, until intrinsic hand muscle atrophy


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DISC ROOT REFLEX MUSCLES SENSATION

C4-C5 C5 Biceps Deltoid

Biceps

Lateral arm

C5-C6 C6 Brachioradialis

(Biceps)

Wrist extension

Biceps

Lateral forearm,

thumb, index finger

C6-C7 C7 Triceps Wrist flexor

Finger extension

Triceps

Middle finger

C7-C8 C8 - Finger flexion

Hand intrinsic

Medial forearm, ring,

small finger

C8-T1 T1 - Hand intrinsic Medial arm


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Special Test:

Compression Test

Distraction Test

Spurling Test


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Compression testProcedure: Axial compression is applied

to the cervical spine in theneutral (0) position.

Assessment:

Compression of the intervertebral disks

and exiting nerve roots, the facetjoints, and/or the intervertebral

foramina increases a radicular, strictly

segmental pattern of symptoms. The

presence of diffuse symptoms thatare not clearly specific to any one

segment may be regarded as a sign of

ligamentous or articular functional

impairment (facet joint pathology).


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Distraction test

Differentiates between

radicular pain in the backof the neck, shoulder,andarm and ligamentous ormuscular pain in these

regions.Procedure: The patient is

seated. The examinergrasps the patientshead

about the jaw and theback of the head andapplies superior axialtraction.


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l


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Spurling test

Procedure:

The patient is seated with the headrotated and tilted to one side. Thepatient bends or laterally flexesthe head to the unaffected sidefirst, then to the affected side.With the other hand, theexaminer lightly taps (compresses)the hand resting on the patientshead

Assessment:

If pain radiates from the cervicalspine down the patientsarm thetest is considered to be positive.


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Supporting examination:

X-ray Cervical AP / L / Oblique MRI Cervical


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Differential diagnosis:

1. Thoracic Outlet Syndrome

2. Carpal Tunnel Syndrome


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Management :

1. Medical NSAIDs

Muscle relaxan

Neurotropic

2. Rehabilitation Program Modalities : SWD / MWD / or USD

TENS

Cervical Traction

OP : Soft Cervical Collar : remainding

Home Exercise Program

Neck Cailliet Exercise Posture Correction

3. Surgical


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cervical root syndrom 43

k ll


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Neck Calliet exercises

cervical root syndrom 44

Flexion. Have the patient place both hands on the forehead

and press the forehead into the palms in a noddingfashion while not moving

Side bending. Have the patient press one hand against

the side of the head and attempt to side-bend, as if trying

to bring the ear toward the shoulder but not allowingmotion.

Axial extension. Have the patient press the back of the

head into both hands, which are placed in the back, near

the top of the head Rotation. Have the patient press one hand against the

region just superior and lateral to the eye and attempt to

turn the head to look over the shoulder but not allowing

motion.


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MANUVER ADSON

Tes ini dilakukan denganmempalpasi pulsasi arteri

radialis setelah lengan

pasien diletakkan pada

posisi anatomis (abduksi 15o

dan supinasi), leher

dirotasikan secara aktif ke

sisi yang diperiksa.

Dinyatakan positif jika

pulsasi arteri radialismengalami obliterasi pada

saat inspirasi dalam.

l d ( l l )


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Manuver Halstead (costoclavicular)

atau tes posisi militer

Dilakukan dengan

retraksi scapula dan

depresi bahu. Tes ini

dinyatakan positif jika

ditemukan obliterasi

pulsasi arteri radialis

atau ada reproduksi

dari gejala.

Manuver Allen


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Manuver Allen

. Tes ini untuk mengetahuiadanya kompresi pada thoracicoutlet. Pasien dalam posisiduduk. Lengan yang sakitditahan pada posisi fleksi siku90o. Pemeriksa mempalpasiarteri radialis, tanganpemeriksa lainnya menahanpunggung pasien. Kemudianpemeriksa mendorong lenganpasien sehingga bahu ke arahhiperekstensi dan rotasiinternal. Kemudian pasiendiminta menolehkan kepala kearah kontralateral dari sisiyang diperiksa. Dinyatakanpositif jika terjadi obliterasiarteri radialis, nyeri pada bahudan lengan, iskemia, danparestesi.


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Tujuan :

Membatasi nyeri

Memaksimalkan fungsi

Mencegah cedera lebih lanjut

Stabilisasi termasuk :

Fleksibilitas spina servikal Reedukasi postur

Penguatan

Stabilisasi


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Outer annulus

fibrosus

Inner annulus

fibrosus

Nucleus pulposus


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STRUCTURES OF IVD :

1.Outer Annulus : Fibroblast cells

Collagen I

2.Inner Annulus : Chondrocyte-like

cells Collagen II

3.Central Nucleus Pulposus

4.Vertebral endplate : hyalinecalcified

cartilage

cervical root syndrome sc4

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