At Range of Motion Physical Therapy, Lucan I had a client who works as a tiler report with thoracic pain and shoulder pain, he also had pain traveling down his left arm to his elbow. He could not sleep with the pain down the arm and had to keep moving to find a position of ease, he was also restricted in neck extension and rotation to the involved side.

Treatment 1: following assessment it was evident T4 L facet was jarred causing shoulder and neck muscle tightness with Radial nerve referral to his elbow. My treatment involved soft tissue work to his neck, shoulder and (Massage with Movement) MWM mobs to thoracic and cervical spine. I completed the treatment with Dry Needling to the thoracic region. Two days later the client reported a small improvement but following a days work the symptoms came back worse than ever, so much so he had to take a day off work.

Treatment 2: The clients referral had moved past his elbow to his thumb and index finger. Again I carried out some more thoracic and cervical MWM mobs, I followed up with some additional soft tissue work to neck, shoulder and upper arm. My treatment also included some nerve flossing techniques to release the radial nerve. As home exercises I showed the client how to carry out some self Thoracic mobs and Radial nerve flossing, he was instructed to them hourly or as often as possible.

I contacted the client the following day and he reported he slept for 14 hours, without waking once and had full movement of his neck with just a slight referral into his tricep muscle.

Treatment 3 & 4 comprised of additional STW to neck and shoulders with mobilisations to his cervical and thoracic region, while continuing the nerve flossing techniques.

Two weeks following on from his last appointment the client has reported that he is pain free with full range of motion of neck and shoulder with no referral.

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