Article

Radicular pain in the upper extremity can have a cervical origin terminating at the cervicothoracic junction (C8, T1). Review of the literature suggests
cutaneous representations of T2 nerve root to the axilla, posteromedial arm, and
lateral forearm, suggesting yet another source of upper extremity radicular pain.
A 53-year-old female experienced insidious right upper thoracic pain radiating
into the right axilla, upper arm, and lateral forearm (10/10 numerical pain
rating scale (NPRS)) of 1-week duration. Medical referral suggested cervical
radiculopathy, however, cervical spine examination was unremarkable. She
presented with mechanical dysfunction of C8, T1; T1, T2; and T2, T3 vertebral
segments with restricted cervical extension. Firm compression over the right
lateral aspect of the second and third thoracic vertebrae reproduced her symptoms
markedly. There was a predominance of right axillary pain. Cervical extension
reproduced local upper thoracic pain. Nine treatment visits for a period of 3
weeks addressed mechanical dysfunction at the cervicothoracic junction and upper
thoracic region, comprising manual therapy, corrective exercise, and pain
modalities. Reduction of local tenderness, and radiating axillary and right arm
pain was observed (2/10 NPRS), with improved cervical extension. The second
thoracic intercostal nerve and the adjoining intercostobrachial nerve, medial
antebrachial cutaneous nerve, and the posterior brachial cutaneous branch of the
radial nerve are speculated to be potential symptom mediators. They have a
representation to the axilla, medial and posterior arm, and lateral forearm - a
representation supporting the speculation of upper extremity radicular symptoms
following mechanical dysfunction of the upper thoracic vertebrae.

Langue : ANGLAIS