Left Upper Trapezius Strain Case Study

02/09/16 Progress Report noted that the patient has neck pain, upper back pain, and shooting pain down the arms. The pain is on the left side. It is rated as 3-4/10. It is stabbing, burning, and pins and needles. Medications and rest alleviate the pain. Work, standing, walking, and activity aggravate it. The patient has tried muscle relaxants, strong pain meds, PT, hot packs, and ice, all of which have helped, but he continues to experience substantial pain. The exam revealed that the DTRs were mildly diminished in the left upper extremity.

DOI: 2/24/2016. Patient is a 46-year-old male production technician who sustained injury while he was lifting a heavy door when he felt immediate pain in his right shoulder. Per OMNI, he was initially diagnosed with right shoulder strain.

DIAGNOSIS: Strain of muscle, fascia, and tendon at neck level; Carpal tunnel syndrome, unspecified right limb,;Carpal tunnel syndrome, unspecified left limb; Status post left carpal tunnel release; and Adhesive capsulitis of right shoulder (M75.01).

Physical examination revealed that the patient’s back is less tender. There is facet tenderness over the bilateral L3-S1. There is also slight pain with limited rotation, flexion, and hyperextension. The right lower extremity is noted to be weaker. The lumbar spine examination is positive for seated straight-leg raise on the left and facet loading. As per treatment plan, the patient will be continuously evaluated for medication regimen and make alterations as necessary. It was noted that the patient states that there is continued need for his Zanaflex as necessary for flare-up of muscle spasms until he is able to start up chiropractor therapy again. He will try to discontinue the medication next month with chiropractor therapy. As per office notes dated 5/23/16, the patient’s pain level is 5-6/10. He states continued need for his Zanaflex as necessary for fare-up until he is able to start up chiropractic therapy. He continues to have neck pain with intermittent periods of sharp-stabbing pain over the right side with radiation to the bilateral upper extremities with numbness as well as associated cramping into upper extremity and into fingers. Current medications include Zanaflex, Nexium, Celebrex, and

IW was diagnosed with cervical strain with right arm dysesthesia with what appears lo he chronic regional pain syndrome of her right arm, right shoulder biceps tendonitis and subacromial bursitis with associated impingement, status post subacromial injection x 1, mild medial and lateral epicondylitis of her right elbow, carpal tunnel syndrome by EMG/nerve conduction velocity and reactive depression.

12/16/15 Progress Report indicated that the patient wakes up with headaches. She mentioned headache in the frontal vertex or temporal occipital areas. She also feels imbalance. She denies bruxism and has no significant neck symptoms. She reported having some minor neck tightness. She was being treated with acupuncture 2 X per week and craniosacral therapy 2 X per week. She noted that she was able to read better in the past two weeks. She had difficulty scanning a written page in the past. She also mentioned that her insomnia has slightly improved since initiating these 2 therapies. Physical exam showed no palpable spasms in her cervical region over her muscles of mastication. Cervical range of motion: backward flexion 70 degrees and forward flexion 60 degrees. She was able to turn 60 degrees to each side. She is able to tilt 40 degrees to other side. Comments: Based on the absence of objective findings, she has reached a medical end result with no need for any further treatment. No additional treatment or diagnostic testing is

On March 25, 2016 a 45 year old male patient came in to Mount St. Mary’s Hospital to have x-rays done of his cervical and lumbar spine, hip, shoulder, sacrum and coccyx. The patient indicated that 16 years ago he woke up with a stiff neck that never went away. Along with his stiff neck, the patient stated that he was experiencing lower back pain as well for the past 16 years. The patient also specified that recently he had started suffering from pain in his right hip and right shoulder. When asked, the patient stated that he had not had any injuries to cause the pain. The patient also indicated that he had never had any surgeries to his lower back or neck. For this case study we will only be looking at the images of his cervical and lumbar

Namely the upper portion of the trapezius muscle laterally flexes the head and the neck towards the same side, and assists in extreme rotation of the head so that the face turns to the opposite side. It can draw the clavicle backwards and raise it by rotating the clavicle. It usually helps to carry the weight of the upper limb during standing, or support a weight in the hand with the arm hanging. Acting bilaterally, the upper fibers extend the head and the neck .The upper trapezius can reflect headaches on the temples, dizziness, severe neck pain, intolerance to

There was decreased range of motion and positive Spurling’s. Trigger points were noted over the bilateral trapezius, suprascapularis, and dullness to pinprick to both hands. There was weakness to grip 1st and 2nd digit opposition, and 1st and 5th digit opposition bilaterally. Deep tendon decreased 1/4 bilateral triceps/biceps.

Based on the progress report dated 06/02/16, the patient presents for evaluation of her left wrist. She is still having a lot of symptoms. She did have a repeat nerve study which showed normal.

On examination, there is tenderness in the right trapezius musculature extending down into the right shoulder girdle. Right shoulder range of motion (ROM) is full with pain at end range. Impingement testing was mildly positive. There is a los tenderness in the right knee with range of motion

S: TM is here for s/p ESI X 9 visit follow up for his right hand and wrist pain and also for RUE Neurometrix test. TM reports his current pain is at 7/10. During the Shutdown his pain has improved some, but still waking him up at night with pain and numbness in his right hand and arm, relieved by shaking or rubbing the hands. TM also reports, numbness and the pain occurs during waking hours, when he is driving, talking on the phone, and occasionally when he is using the hands for repetitive maneuvers. When the heat was applied to his

Looked at different test to see how much strength and stability they had within their shoulder. Each one then worked with their participants to see how effective the dry needling would be for them and the severity of their injury. According to Neurophysiological and Clinical Effects of Dry Needling in Patients with Upper Trapezius Myofascial Trigger Point written by Maryam Abbaszadeh-Amirdehi, PhD, PT; Noureddin Nakhostin Ansari, PhD, PT; Soofia Naghdi, PhD, PT; Gholamreza Olyaei, PhD, PT; Mohammad Reza Nourbakhsh, PhD, PT. In the article, it talks about how the primary source of muscle pain in skeletal muscle was due to the myofascial trigger points, the pain is defined by localized, hyperirritable spots in a palpable taut band of skeletal muscle fibers, which occurs mostly in the neck and shoulders, most commonly the trapezius (Abbaszadeh-Amirdehi, M., Ansari, N. N., Naghdi, S., Olyaei, G., & Nourbakhsh, M. R. (2017)). Out of the five articles that was looked at for this paper the research study Exercise and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial written byJose L. Arias-Buria, Cesar Fernandez-de-las-Penas, Maria Palacios-Cena, Shane L. Koppenhaven, and Jaime Salom-Moreno. This group of researchers did their study a little differently, instead of doing a eight week project like the others instead they had a one year fallow

PURPOSEOF EXERCISE:- To develop the trapezius muscles. This exercise can be done extremely heavy to thicken the traps, which really helps you in doing back poses.

My Research topic is a comparative study to evaluate the effectiveness of Bowen Technique and Positional Release Therapy on Trapezitis.