Soft Tissue Mobilization Versus Therapeutic Ultrasound for Subjects With Neck and Arm Pain

Inclusion Criteria

• Active movement dysfunction that could be related to mechanical sensitivity of the neural structures of the upper limb. (i.e. painful shoulder abduction with elbow extension that is limited more when the wrist is extended than when the wrist is in neutral.)
• Positive response to upper limb neural provocation testing (ULNT 1) (see description below for details)
• Tenderness to palpation over the cervical nerve trunks, brachial plexus, or along the median nerve.
• Tender points or taut bands in the muscles of the upper quadrant including the scalenes, cervical paraspinals, trapezius, deltoid, pectoralis major or minor, rotator cuff, biceps, triceps, coracobrachialis, brachialis, radiobrachialis, pronator teres, supinator, forearm extensor, forearm flexor, pronator quadratus, and hand intrinsic muscles.

Exclusion Criteria

• Red flags noted in the medical screening questionnaire such as tumor, fracture, history of metabolic disease, prolonged history of corticosteroid use.
• Signs of central nervous system involvement such as hyper-reflexia (exaggerated response to deep tendon reflex testing), unsteadiness during gait, ataxia, disturbed vision, nystagmus, altered taste, positive Babinski's or Hoffman's reflexes.
• Cervical spine surgery within the last 3 months.
• Litigation associated with their neck and/or upper limb pain.
• Insufficient English language skills to complete the questionnaires and follow-up instructions.
• Inability to complete the treatment and follow-up schedule.
• Current pregnancy.