cervical disc prolapse

[P.T.]

HELLO;
i'm in internship and i have lady 32years old with C4-5 disc prolapse and the disc is severly bulged. She has radiating pain for both UL BUT the muscle power is 5 and the ROM is full.

thr problem is the pain was increased with IFT, hotpack and US.
then i changed the treatment plan by used of TENS and hotpack BUT the pain was increased.

SO; what can i do to control the pain and is the PT will be effective for this patient???

pleeeeeeeeez help me to solve this prblem.
thanx..

[kebejnr]

hi
do u have the X-ray and if yes have u done some manipulation and u did not mention ur assessement procedures. infact i need a detail assessement procedure so that i will knoe what to do.
take care

[MGrules]

Hi there,
If your patient has acute disc prolapse then she needs to be put on continous cervical traction for which she will have to get admitted in the hospital. If the pain is chronic then she will be have to be given traction which shall push the disc into the place and then pain shll surely reduce. In such cases always see for pain or tingling during sneezing. If tingling still persist then the disc is still impinging. ULTT can be given later with neck exercises. Hot pack should be given after traction or TENS also can be given. TENS will work better. If any muscular weakness then strengthening should be carried out. Cervical collar a hard one and good Ergonomic advice should give your patient relief. BUT FIRST TRACTION SHOULD BE GIVEN.

[P.T.]

hi kebejnr:
i saw the X-ray she had sever herniated disc and some little osteophytes..

MGrules thanx 4 ur answered but as i told u the ms. power is 5 and the IFT, HOTPACK and US increaded the pain....


help me to end the suffering of the patient

[drparakram1984]

hi first you should take him to continuaus traction for 45 minutes and then TENS.

[P.T.]

hi; but how can i use traction if there are osteophytes?????

[linbin]

hi friend
i am not understanding why you are concerned about osteophytes ,and why you are hesistant to go for cervical traction because of this
you are mentioning that there are some osteophytes.thats normal as you grow older.ROM is full so these osteophytes are less troublesome.if the patient experiences giddiness,nausea etc while applying manual traction then i agree with you
if you are concerned whether kinking of vertebral artery will occur,as far i remember the kinking occurs if rotational movement is there.since we are giving traction in neutral rotation there is no question of kinking
i would like to know your point of view.
as a treatment option you can try sliders,cervical lateral glides

[Dr Damien]

I agree that the treatment should be traction and the use of electrotherapy was a waste of time really form the onset but before you consider traction use you might want to clarify that your patients past history is clear of any contraindications, if you are worried about VBI(artery insufficiency) then test it. I advise you do all this before you begin manual therapy in the neck or traction of any kind. 32year old does not seem like osteophytic changes will be a problem by the way.U can see how she reacts to intermittent manual traction first before putting her on continous, if symptoms are relieved then you can consider the continous mechanical traction thingy.This practice is the safe way for the neck which is problematic for physios generally, so do not worry about it.You can do unilateral mobilizations just to ensure that joint play is fine in the spine as an added treatment.