Publication Date

Spring 2015

Document Type

Project Summary

Degree Name

Doctor of Physical Therapy

Department

Physical Therapy

First Advisor

Roberta O'Shea, PT, DPT, Ph.D.

Second Advisor

David Diers, Ed.D., MHS, PT, ATC

Third Advisor

Russell E. Carter, PT, Ed.D.

Abstract

Background and Purpose: There is a lack of research using conservative treatment to treat chronic traumatic brachial plexus injuries. The purpose of this study was to examine the impact of a physical therapy treatment plan and home exercise plan (HEP) for a 47 year old male referred for shoulder pain following a traumatic compression injury 11 months ago.

Case Description: This study contained interventions focused on increasing joint mobility, resistance training, massage, and modalities to decrease patient symptoms and improve quality of life. To measure outcomes, the following examinations were used: numeric pain rating scale, gross shoulder manual muscle testing, AROM of the glenohumeral joint, DASH, and pectoralis minor MLT to evaluate muscle tightness versus guarded posture.

Outcomes: The patient showed limited to no improvement in each of the measures used to take from baseline to discharge. Slight improvements in AROM of the shoulder noted from 92ᵒ to 99ᵒ shoulder flexion and 84ᵒ to 104ᵒ shoulder abduction, no change in gross strength, and no change in DASH score. The patient was able to relax in the supine position over a period of 25 minutes to allow his right upper extremity to rest on the table for an accurate pectoralis minor MLT, the right shoulder measures 18 cm and left measured 15 cm.

Discussion: The results of this study emphasize early conservative treatment with brachial plexus injuries as well as the complexity involved when treating patients with chronic traumatic injuries. This case report adds a chronic component to the brachial plexus literature that is currently lacking. Additional research could include a study focused on specific interventions related to improving joint mobility, preventing muscle atrophy, and decreasing pain would be beneficial to the small population of traumatic brachial plexus injuries as well as the chronic BPI.

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