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
Extension F/F (0-300) 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
Extension F/F (0-800) 5/5
Big Toe ROM MMT
Flexion
MTP F/F (0-250) 5/5
IP F/F (0-250) 5/5
Extension F/F (0-800) 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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34
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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