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Case - Right Sided Neck Pain with Best suited Sided Jaw Paratheisa


Case - Right Sided Neck Pain with Right Sided Jaw Paratheisa

Clinical Reasoning Case Study

Male with right sided neck pain with right sided jaw paratheisa

This essay will concentrate on a case study of a male person experiencing right sided neck pain with proper sided jaw parathesia. The author hopes to describe the patient’s voyage from initial assessment to discharge write my essay free. The author hopes to detail how a clinical hypothesis was produced. This hypothesis will come to be backed up by sound medical reasoning abilities and current facts based research.

Subjective Examination:

History of Presenting Condition (HPC):

A fifty four calendar year old male offered scholarship essay examples to the clinic complaining of right sided neck pain with right jaw parathesia. Patient described a long history (> a decade) of neck “stiffness” and upper trapezius “tightness” and “tiredness” (Pain A). It was always of insidious starting point. He reports these episodes would come and go but would always relax. He under no circumstances received any physical treatment for this pain. He felt heat remedy helped settled it down. Yet, in the last four weeks he felt Pain A again. This time around it didn’t settled down and he felt it obtain progressively worse. Then in the last 4 days he started to experience a constant numbness around his still left jaw area (Discomfort B).

The Patient explained Pain A as:

A Constant pain however the strength could change. He described it as a 9/10 on the Numerical Pain Rating Scale (NPRS) (Williamson & Hoggart 2005) at its worst. He described it as 4/10 on NPRS at its best. He would occasionally get a sharp shooting soreness. He likewise reported hearing clicks. Turning to his head to kept, extending backwards and moving in bed where his mot aggravating elements. He felt some comfort when he was on the move and found walking helpful.

The 24 hour for Pain A was the following:

AM- Upsurge in the pain (8/10) but would ease by the time he previously his breakfast (5/10)

Day- Could get worse or better according to what he did but overall just a little better

Night- At its worst (9/10) and would wake him from his sleep

The patient described Pain B as:

A Constant numbness with no change. Even when Soreness A would ease Pain B would stay the same. There is no 24 hour style.

The individual reported no apparent warning flag. He reported no drop episodes, dizziness, dysphasis, dysarthia or diplopia (Considered as the 5 D’s). He reported no nausea, ipsilateral numbness or nystagmus (3 N’s). He reported no ataxia.

Past Medical History:

Hypertension for which he takes Aldactone.

High Cholesterol that he takes Mevacor.

Gout 2002.

No cancer, no unexplained weight damage/gain, no steroids, no epilepsy, no respiratory disease.

Social history:

Patient reported he spent some time working as a civil servant in the taxes department for almost 23 years. He likes taking walks and bowls. He reviews no apparent yellow flags.

Clinical Reasoning from the Subjective Interview:

A key analysis theory proposed by Maitland () may be the acronym “SIN” (severity, irritability, nature) which is employed to guage a patient’s state. Form the subjective interview the writer concluded that the patients:

Severity-moderate to high

Intensity: moderate

Nature: Mechanical & Inflammatory

Taking in to the account the patient’s pain location and key aggravating elements of compression( expansion and left rotation), the facets joints of the cervical spine (C-Backbone) where considered a feasible source of the patients pain. Soreness referral habits of the cervical backbone facets researched by Cooper et al (2007) back again this hypothesis up. When the 24hour routine is analysed, this implies a degenerative pattern which could further results the nerve roots in the spine (Penning 1992). The patient does survey his symptoms are worse at night and this may suggest nerve ischemia (Glifford 2001). When further analysed, the increase in night pain was from the mechanical movement of submiting bed. The author likewise felt that joint discomfort would mostly likely be accompanied by muscle tissue dysfunction. It is well highlighted that muscle mass imbalance can develop after the onset of soreness and is prevalent in chronic discomfort syndromes (Nijs et al 2012, Falla et al 2004).

Pain B (jaw paraesthesia) was insidious after onset of Pain A. This may signify a relationship between the Pain A and Pain B. Trigeminal neuralgia, carrying out a compromise at the still left top cervical facet joint was hypothesised. Possible other notable causes of trigeminal neuralgia could not be fully ruled out either.

Clinically reasoning form the subjective interview the writer developed the next working hypothesis:

  • Arthrogenic: (50%) C0-C3, C4/C5, C5/C6, Cx/Tx junction
  • Neurogenic: (30%) Trigeminal neuralgia? Cervical root compromise
  • Myogenic: (20%) Cervical Lean muscle imbalance

This working hypothesis manufactured the author aware of “MUST, SHOULD,COULD” process for the objective examination and is proven in the diagram below:

Must :



Functional Marker


Sensory assessment

Active Cx movements

Active Tx movements

Oculomotor assessment




Shoulder girdle(Press check)


Neural mechanosensitivity

Objective Examination

Objective Examanation:

The patient presented with a forward head posture, increased thoracic kyphosis and heightened anterior pelvic tilt. He was area flexed to the left at the Cx backbone and side flexed left at the Tx. The cervical assessment findings are displayed in the diagram below:

As proven in the diagram, the objective assessment determined a hypomobile C2/C3 facet joint with reproduction of the jaw parartheisa. The Cx/Tx junction was likewise found to be hypomobile.

The patient was also found to obese weighing 113 kilograms. The cranio cervical flexion test out (CFFT) found extreme recruitment of the sternomastoid and scalene muscle mass. The ULTT appeared typical for left and right with elbow extension at -20 degrees elbow the patient reported a cubital fossa draw. There was no rise with Cx aspect flexion. The patient was likewise found to over weight weighing 113 kilograms.

Clinical Reasoning from the Objective Examination:

The patients onward head posture combined with his left sided mind tilt could be a causative factor predisposing him to facet joint problems. A significant nerve root compression cannot be excluded either. Combined extension & rotation to the same area is the key indicator of nerve root compromise. The individual became more alert to his jaw paratheisia with palpation of the C2/C3 facet joint. This supports the original hypothesis that the clients pain was of a cervical origin. The neural examination appeared normal. However the length and history of his his cervical soreness does indicate some centrally sensation.However weighing up the evidence the author felt his symptoms adopted a far more mechanical and peripheral nociceptive supply keeping inline with degernation of the facet joints.

Physiotherapists rely tremendously on the use of manual and diagnostic testing and manual to achieve an accurate diagnosis. Unfortunately there exists a real lack of quality data to back up almost all of the

However the objective findings, in conjunction with the whole assessment, helped support the initial hypothesis of a solid arthrogenic part. This cluster-examination process may be the only way to improve a precise diagnosis.

This helped to confirm the SIN element: S-Mild/Moderate


N- Mechincal (80%) Inflammatory (20%)

Based on the results from the objective exam, the author chose that the trament system would revolve around

(a) Education

(b) Manual Remedy to the sympotomativ joints

(c) Address poor muscles control and postural awareness


The first treatment session centered on Posterior-to-Anterior Glides Grade 3 that have been applied unilateral on the right side at C2/C3. The required effects of this manual remedy was to impact nocicieptive barrage in to the dorsal horn and facilitate discomfort suppression mechanisms from the mind ( Gross et al 2008, Vernon et al 2007). Coppieters et al (2003) found it to help and maintain neural tissue health. Manual therapy was also found to decrease the experience of the superficial throat flexors (Sterling et al 2001).

Much research has highlighted that disturbed muscle mass patterns can nonetheless linger despite quality of discomfort. If these patterns aren't addressed properly the condition can returning. A biofeedback was equipment was used to enhance the cooradination of his lean muscle activity ( Hodges 2011, Panajabi 1992).

Follow up treatment

The treatment progression focused on combined PPIVMS and PAIVMS

Neuromuscluar control

After 4th session

Patient reported total movment of the cervical spine, no pararthesia, no discomfort throughout the day but was still experiencing pain upon submiting bed.

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