ORTHOPEDIC MANUAL PHYSICAL THERAPY MANAGEMENT OF A 33 YEAR-OLD FEMALE WITH A 3 YEAR
HISTORY OF PROGRESSIVELY WORSENING LEFT UPPER QUARTER SYMPTOMS BEGINNING
Manual Therapy Fellowship
Purpose: The purpose of this case report is
to describe the multimodal, Orthopedic
Manual Physical Therapy (OMPT)
management of a female patient presenting
with a 3 year history of progressively
worsening left upper quarter symptoms.
Subject: A 33 year-old female presented to
physical therapy services approximately 3
years after surgical cardiac pacemaker
implant for hypocardiac issues. Upon waking
from surgery, she noted symptoms in her left
upper quarter region. As part of her cardiac
post surgical management, she was placed in
a sling and instructed not to elevate or abduct
her arm greater than 80–90 degrees for 3–4
months. After 3–4 months, she removed the
sling and resumed her usual work and
recreational activities but was limited by her
progressing left upper quarter symptoms.
Due to the continued progressive nature of
her symptoms over the course of 3 years, she
sought further medical management and was
referred to physical therapy.
Symptom Description: Constant “tightness
and deep ache” in left armpit region which
could extend up to her left lateral cervical
spine and jaw region.
9 Month Follow-Up
IMMEDIATELY AFTER SURGICAL CARDIAC PACEMAKER IMPLANT: A CASE REPORT
Bryan Dennison, PT, DPT, MPT, OCS, CSCS1, 2
1
Fellow - Regis University Manual Therapy Fellow, Denver CO.
2
Affiliate Faculty - Regis University, Denver CO.
Email: bdenniso@regis.edu
Physical Examination: Results (cont):
•Limited left shoulder active range of motion in flexion and •Axillary symptoms increased with neurodynamic testing of left • Serratus anterior muscle test
abduction. median and radial nerve (wrist sensitizing maneuver). increased to 5/5 after 5 visits with no
•Left scapular winging (observed with push-up plus) •Clinically noted reduction in thoracic spine P-A accessory joint visible winging observed.
motion • No reproduction of axillary
•Serratus anterior muscle test: Left = 4/5, Right = 5/5
symptoms with neurodynamic testing.
•Clinically noted reduction in left glenohumeral accessory joint
•Observed decreased muscle mass left deltoid vs. right
motion with reproduction of axillary symptoms. • No symptoms into her upper left
arm, lateral cervical spine or jaw.
OMPT Management (13 visits over 7 weeks)
Thoracic Spine Thrust And Non-Thrust Glenohumeral Joint Mobilizations Out Neurodynamic Mobilizations Therapeutic Exercise
•Able to return to work and
Mobilizations Of And In Neurodynamic Positions recreational activities (rock-climbing)
without symptoms or difficulty.
Discussion: The patient exhibited
improvements in her impairment
measures and decreases in her self-
report measures after 7 weeks of
multimodal OMPT management.
These changes were maintained at 9
month follow-up.
Conclusion: A multimodal OMPT
management approach seems to have
produced effective and lasting results
in a 33 year-old female with a 3 year
history of complex upper quarter
symptoms following cardiac
pacemaker surgery.
Clinical Relevance: OMPT
management should be considered in
Results:
patients with complex upper quarter
NPRS SPADI Quick DASH Flexion Abduction symptoms. Future research should
continue to investigate multimodal
Initial 6/10 43.75% 50% 137° 153° OMPT management of patients with
Discharge .66/10 0% 10% 170° 176° complex upper quarter symptoms to
help guide decision making for these
0/10 0% 0% 171° 180° patients.