Thoughts and feelings?
This was a good pt to see on my last day as she was a person that presented with medial elbow pain and pins and needles that extended down to the last three digiots of her hand. It was a chance to perform a thorough objective exam and use my clinical reasoning as to why she was getting symptoms. It turned out that this lady, as result of prolonged driving, had increased tone in her pec minor and scalenes which resulted in ulnar nerve irritation and medial elbow pain. I enjoyed seeing the pattern to her symptoms unfold and being able to treat this lady so that she had no pain by the end of the Rx session with our asterisk, neurodynamic test.
How do you think you managed?
I think I did quite well. When it came to treating the lower cervical/upper thoracic spine, I was a bit unsure of what passive accessories we should perform to open up the IVF however once I had talked it through I was able to understand the reasoning behind each PAM. It was great to get such a positive effect from treatment.
What changes would you make?
Just remembering to retest your asterisk sign after each treatment method. I thinkl after the first technique I decided to retest using grip strength however I then realised that her neurodynamic test for the ulnar nerve was more of a asterisk sign.
What strategies could you incorporate?
Take the time to think about which is the best test to re-test post Rx.
Overall thoughts?
Quite pleased with how we performed the assessment and treatment. It was systematic which made it easier clinically reason as to why this pt was getting her symptoms.
I would like to ask the physio what are the usual points where nerve irritaion in the thoracic outlet can occur.
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