title: Immediate and lasting effects of a thoracic spine manipulation in a patient with signs of cervical radiculopathy and upper extremity hyperalgesia: A case report.
abstract: Patients with cervical radiculopathy (CR) may present with accompanying symptoms of hyperalgesia, allodynia, heaviness in the arm, and non-segmental pain that do not appear to be related to a peripheral spinal nerve. These findings may suggest the presence of central or autonomic nervous system involvement, requiring a modified management approach. The purpose of this case report is to describe the treatment of a patient with signs of CR and upper extremity (UE) hyperalgesia who had a significant decrease in her UE pain and hypersensitivity after a single thoracic spine manipulation (TSM). A 48-year-old female presented to physical therapy with acute neck pain radiating into her left UE that significantly limited her ability to sleep and work. After a single TSM, the patient demonstrated immediate and lasting reduction in hyperalgesia, hypersensitivity to touch, elimination of perceived heaviness and coldness in her left UE, and improved strength in the C6-8 myotome, allowing for improved functional activity capacity and tolerance to a multi-modal PT program. Based on these results, clinicians should consider the early application of TSM in patients with CR who have atypical, widespread, or severe neurological symptoms that limit early mobilization and tolerance to treatment at the painful region.
authors.affiliation: a UT Southwestern Medical Center , Department of Physical Therapy , Dallas , TX , USA.
authors.forename: Beth K
authors.initials: BK
authors.lastname: Deschenes
authors.affiliation: a UT Southwestern Medical Center , Department of Physical Therapy , Dallas , TX , USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Zafereo
mesh_terms: D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020393:Manipulation, Spinal; D008875:Middle Aged; D010147:Pain Measurement; D011843:Radiculopathy / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000294:innervation*
keywords: Cervical radiculopathy; spinal manipulation; sympathetic mediated pain