Case Study: Neck

Mrs. Billo is a 59-year old married woman who has difficulty performing her activities of daily living. She has been unable to resume the work she did for over twenty years in the Export Department of a major freight operator, where her job involved computer data entry, paper work related to freight orders and administrative office tasks.

Medical Information

MRI of cervical spine showed mild-moderate disc bulge at C5-6 with encroachment and mild bulge at C6-7; MRI of right shoulder indicated possible partial tear supraspinatus tendon and mild acromioclavicular joint hypertrophy with subacromial impingement. Nerve conduction and EMG studies were consistent with bilateral carpal tunnel syndrome, L > R.

Activities of Daily Living

Mrs. Billo performs all daily tasks slowly, as she now relies primarily on the non-dominant left arm. She has difficulty raising her arm to don/doff overhead garments; cannot do rear garment zippers/fastenings; avoids buttons and zippers; and now wears pants with elastic waistbands. Her arms fatigue easily while washing and blow drying her hair. Mrs. Billo does limited driving because of reduced rear viewing.

Mrs. Billo’s husband helps with homemaking tasks of cleaning, shopping and the laundry. She experiences pain after briefly pushing a vacuum or mopping; needs assistance to open jars, cut and prepare food, transfer large pots and pans to and from the stove or oven, and to retrieve items from high shelves.

Occupational Information

Mrs. Billo's job is best described in the Dictionary of Occupational Titles (U.S. Department of Labor, 4th edition, 1977) and Selected Characteristics of Occupations Defined in the Dictionary of Occupational Titles (1981), as follows:

214.362-14 DOCUMENTATION-BILLING CLERK (air. trans., motor trans., rr. trans., water trans.)
213.362-10 COMPUTER OPERATOR (clerical) console operator

According to the D.O.L, the job duties of a billing clerk are associated with sedentary work demands and the duties of computer operator are associated with light physical demands. Mrs. Billo’s actual job had light physical demands (frequent lift/carry up to 10 pounds and occasional lift/carry of up to 20 pounds).

Key Evaluation Findings

• Limited, guarded, slow and painful cervical spine mobility in all planes
• Reduced right shoulder mobility (65% for flexion and abduction, 50% for internal and external rotation)
• Reduced strength (50% for grip and pinch patterns in comparison to normative data for women her age)
• Consistency of effort on repeated strength testing
• Positive Tinel’s test at the wrist, bilaterally
• Inability to perform repeated fine or medium coordination hand tasks
• Inability to maintain a comfortable head posture when downward viewing is required for hand tasks
• Writing tolerance of < 5-minutes before stopping because of numbness
• Hand/arm and neck discomfort when typing for 15 minutes
• Limited tolerance to perform brief or light lifting and carrying tasks
• Occasional lift capacity of 5-pounds at below waist level
• Occasional overhead lift capacity of 1 pound

Ms. Billo cannot comfortably keep her hands at the computer more
than briefly, even when adjustments are made to the location of the keyboard.

Summary

Mrs. Billo has significant mobility restrictions of the cervical spine and right shoulder. She avoids neck flexion whenever possible and uses downward eye gazes to view paper or objects at table or desk level. Mrs. Billo’s active cervical motion is reduced in all planes by at least 25% and right shoulder elevation is limited by >50%; she cannot elevate the arm to the 90 degree level. Mrs. Billo has significant reductions in functional hand grip and pinch strength, with grip strength reductions of 50% or more, bilaterally.

Mrs. Billo’s sitting tolerance is limited to one hour;lifting and carrying are limited to 5 pounds or less. Any activity aggravates her symptoms and is associated with increased upper arm strain. Writing is limited to <10 minutes at one time because of resultant hand numbness. Computer keyboard and chair adjustments are required to provide basic comfort for short duration keying.

The findings of this FCE indicate that Mrs. Billo’s cervical disc disease, right shoulder rotator cuff tear and bilateral carpal tunnel symptoms preclude her work performance for repeated hand usage without symptom exacerbation or to perform data entry or clerical work tasks that are associated with sedentary and light work demands.

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