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Upper Extremity Paresthesia in a Collegiate Swimmer
Ayotte J, Rothbard M, Morin G: Southern Connecticut State University, New Haven, Connecticut
Background:
A 20 year-old male individual medley and backstroker presented with idiopathic persistent
cervical spine pain and paresthesia in the upper extremities and jaw. Reported symptoms started four years ago
bilaterally, but recently became more prevalent on the right side. He reported being able to perform sport
activities on a self-limiting basis. Symptoms increased throughout the day and decreased with lying down. The
patient’s medical history was not significant for traumatic injuries to the spine or surrounding area. Visual
observation revealed increased cervical lordosis with forward carriage of the head and chin protraction along
with thoracic kyphosis and associated rounded shoulders. Physical examination elicited bilateral diffuse cervical
spine tenderness, upper cervical extensor muscular spasms, and normal skin temperature. AROM testing
revealed lower cervical and upper thoracic spine hypomobility and induced symptomatic increases with bilateral
cervical extension, lateral flexion, and rotation. PROM testing revealed sternocleidoid, trapezius, levator
scapulae, and pectoralis major and minor tightness. MMT elicited deep anterior cervical, serratus anterior, and
scapular retractor weakness. Cervical compression, cervical distraction, Spurling’s, Roos, and military brace
tests were positive; however, valsalva maneuver and Adson’s and Allen tests were negative. Neurologic testing
revealed significant bilateral sensory and motor deficits over the entire right upper quarter. Differential
Diagnosis:
Rheumatoid arthritis, multiple sclerosis, tumor, cervical spondylolysis, degenerative osteoarthritis,
spinal stenosis, cervical disk herniation, clinical cervical instability, facet joint dysfunction, degenerated facet
joint, and cervical radiculopathy. Treatment: The patient was referred to the team orthopedist and removed
from athletic participation. Following initial consultation he was referred to a neurologist who ordered blood tests
and an MRI of the brain and cervical spine. Blood tests were normal. The MRI of the cervical spine revealed
mild asymmetric right-sided uncovertebral hypertrophy at C2-C3 and C3-C4 with mild-to-moderate
neuroforaminal stenosis. A mild mass effect on the left axillary sleeve at the C3-C4 segment was noted. A small
subannular fissure and left central/subarticular disc protrusion encroaching on the left axillary sleeve and neural
foramen at C5-C6 was observed. The neurologist diagnosed the patient with polyradiculopathy secondary to
C2-C6 neuroforaminal spinal stenosis and was prescribed Carbamazepine ER for abnormal nerve sensations,
Voltaren for inflammation, and rehabilitation to facilitate recovery and function. The rehabilitation program
involved an integrated approach and was designed to control inflammation, provide symptomatic relief for
radicular pain and muscular spasms, and to decrease cervical nerve root compressive forces. It consisted of
physical agents, postural retraining, manual therapy, kinesiotaping to encourage correct posture, and
therapeutic exercises to release tight structures and strengthen postural muscles. Status post four months his
symptoms improved, but did not completely resolve. Participation was self-regulated and related to pain levels
and neurologic deficits. Status-post six months his symptoms completely resolved. He was cleared for
unrestricted activity. His return to swimming did not elicit any pain or neurologic deficits. Uniqueness: Most
common clinical symptoms of polyradiculopathy are neck pain and unilateral arm pain accompanied by motor
and sensory deficits. The prevalence of polyradiculopathy secondary to spinal stenosis increases with age and
most commonly occurs at C6-C7 and in adults over 30-40. Furthermore, the patient is a post-pubescent athlete
who developed early onset cervical spinal stenosis. Finally, only 2% of all cervical radiculopathies occur at C4-
C5 or above. Conclusions:. Polyradiculopathy refers to compression or damage of more than one spinal nerve
root that produces pain and neurologic deficits. This occurs when the spinal column narrows and places
pressure on multiple nerve roots. The lower cervical nerve roots (C5-C8) are most commonly involved. Various
etiologies can result in pressure on one or more cervical nerve roots. In this case, the pathology was caused by
neuroforaminal spinal stenosis secondary to overactivity. Word Count: 600

Source: http://www.goeata.org/protected/EATACD13/downloads/PDF/abstract-Ayotte.pdf

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