Document Type

Case Report


Physical Therapy & Rehabilitation Science

Degree Name

DPT (Doctor of Physical Therapy)

Session and Year of Graduation

Fall 2019


Frey Law, Laura


Background: Neck pain and shoulder pain are two classifications of diagnoses that are very prevalent in the general population. In the case of shoulder or neck pain, it may be important to take a regional interdependence view to the patient’s presentation to ensure a comprehensive understanding of the patient’s limitations. Regional interdependence is based on the thought process that dysfunction in one area of the body may manifest as further dysfunction or pain in a surrounding region. The purpose of this case report is to highlight a regional interdependence view of treatment decision-making in a case of upper quarter pain and dysfunction first diagnosed as three separate pathologies. Case Description: The patient is a 36-year-old senior gardener who presented to an occupational health clinic with neck and shoulder pain. She had significant limitations in cervical and shoulder range of motion in addition to impairments with scapular mechanics. Intervention: Interventions were directed at her primary areas of limitation, as well as further areas of limitation found via the regional interdependence approach of treatment, utilizing the ‘test-treat-retest’ model. The patient received a multimodal approach to her cervical and thoracic spine and shoulder girdle, incorporating manual therapy, therapeutic exercises and activity, and neuromuscular re-education. Outcome Measures: The outcome measures utilized with this patient were active range of motion, pain scale, return to work duties, and self-reported functional improvement. A limitation of this case study is the lack of use of standardized outcome measures, such as the Quick-Dash. Discussion: This case study provides support for a regional interdependence approach for treating patients with multiple chief complaints as a means to create a comprehensive treatment plan.


Physical Therapy; Rehabilitation; Regional Interdependence; Neck-Shoulder Pain; Upper Quarter Dysfunction; Thoracic spine; Manual therapy


15 pages


Copyright © 2019 Ashley Nielsen