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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

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Old 12-06-2008, 02:49 PM   #1
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Default Upper thoracic spine dysfunction

A question for the group
I see a lot of patients with head and neck pain in my practice. I have seen several patients recently with chronic lateral neck and shouldler pain, usually a constant ache with burning type feeling down to the medial scapular border. A common finding seems to be significant restriction of upper T spine motion, usually flattened position at rest, or even one with a reversal of the thoracic curve.
Does anyone have any thoughts on the mechanism or suggestons for treatment approach?
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Old 12-06-2008, 03:03 PM   #2
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Old 12-06-2008, 06:51 PM   #3
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A restriction of upper T spine motion has direct influence on shoulder-arm mobility. Perhaps this can be a cause for relevant nerves to move differently and become "irritated".
I had some astonishing (good) results in using Mulligans technique "snags & nags". For example when abd./elevation is painfull the same movement combined with manual pressure on the homolat. (sometimes the contralat.) side of C5-6 (a kind of manual rotation "impuls") mostly becomes non-painfull and free.

Explanation for this might well be stimulation of rami cutaneii.
I have no proof for this but had many good results.

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