PHYSIOTHERAPY SOAP ASSESSMENT
Left Cervical Rib Excision – Post-operative Brachial Plexus Neuropraxia
PATIENT INFORMATION
Name: Mr. Vaibhav Rao (A. Vaibhav Rao)
Age / Sex: 29 years / Male
Address: Ramgarh, Jharkhand
Occupation: Not specified – recreational gym/weight training and motorcycle use reported
Referred by: Dr. Sanjiv Kumar Sharma, Senior Consultant Neurology (MBBS, MD, DM Neurology, AIIMS)
Hand dominance: To be confirmed on assessment
SUBJECTIVE ASSESSMENT
Chief Complaints
• Weakness of left shoulder and elbow
• Decreased grip strength, left hand
• Difficulty performing overhead activities with left arm
• Impaired activities of daily living (ADLs) using left upper limb
History of Present Illness
The patient was apparently asymptomatic until he developed pain in the left little finger while changing gears on a motorcycle.
The pain was initially mild and activity-related; temporary cessation of gym exercises gave slight improvement.
On resuming weight training and upper limb strengthening exercises, he developed progressive numbness of the entire left upper
limb (hand, forearm, and biceps region), associated with swelling, weakness of grip, inability to grasp objects, and pain in the left
shoulder on overhead activity. Symptoms progressively worsened despite occasional analgesics.
MRI of the brachial plexus revealed a 2.1 cm left bony cervical rib compressing the brachial plexus roots (predominantly C7, C8,
T1) – consistent with compressive/entrapment plexopathy. Initial nerve conduction study (NCS) suggested left C6–C7
radiculopathy.
The patient subsequently underwent surgical exploration and excision of the left cervical rib. Intra-operative traction on the
brachial plexus resulted in post-operative neuropraxia, with complete loss of active movement of the left upper limb on post-
operative day 1 (POD-1). Motor recovery began from POD-2. He received one week of in-patient physiotherapy (positioning,
passive ROM, oedema control, breathing exercises, and graded muscle activation), followed by continued out-patient
physiotherapy elsewhere.
Repeat NCS post-surgery demonstrated left axillary and musculocutaneous nerve axonopathy, with slight improvement noted in
axillary nerve function. He now presents for continued rehabilitation.
Past History
• No prior history of similar complaints before the index episode
• Regular gym / weight-training and motorcycle rider
Personal History
To be elicited – diet, sleep, bowel/bladder, addictions.
Family History
Non-contributory (to be confirmed).
Medical History
No known comorbidities reported (e.g., diabetes, hypertension) – to be confirmed.
Surgical History
, Left cervical rib exploration and excision (2026), for left C6–C7 radiculopathy versus left ulnar neuropathy, complicated by intra-
operative traction neuropraxia of the brachial plexus.
Physiotherapy History
• 1 week in-patient PT immediately post-surgery (positioning, PROM, oedema control, breathing exercises, graded activation)
• Continued out-patient PT under another therapist following discharge
Socioeconomic History
To be elicited.
OBJECTIVE ASSESSMENT
Vitals
Temp / PR / BP / RR: to be recorded at the time of assessment.
Observation
• Built of patient: to be assessed
• Position/attitude of limb: guarded posturing of left upper limb, reduced spontaneous use, consistent with recent
axillary/musculocutaneous nerve axonopathy
• Breathing pattern: to be assessed (patient received breathing exercises post-operatively)
• Facial symmetry: grossly symmetric; not clinically implicated
• Deformities / external appliances: nil fixed deformity reported; well-healed left supraclavicular surgical scar (cervical rib
excision site) to be inspected
• Skin: to inspect surgical scar for healing, oedema, or trophic changes over left hand/forearm
• Posture: left shoulder likely depressed/protracted, guarding pattern to be confirmed
• Gait: not expected to be affected – lower limbs uninvolved
Joint-wise Findings
Joint Right Left
Shoulder Normal alignment, full active ROM, no Guarded posturing; reduced active
restriction abduction/flexion, esp. overhead range (to be
measured with goniometry)
Elbow Normal alignment and ROM Reduced active flexion strength (biceps);
ROM to be quantified
Wrist Normal Grossly normal ROM; grip weakness noted
Fingers Normal Weak grasp, reports numbness left little finger;
no fixed deformity
Hip Normal Normal
Knee Normal Normal
Ankle Normal Normal
Subtalar Normal Normal
Toes Normal Normal
Note: precise goniometric ROM and MMT grades to be recorded at bedside; findings above reflect the clinical pattern expected
from axillary and musculocutaneous nerve involvement and should be confirmed on direct examination.
Palpation
Tenderness / local warmth over left supraclavicular surgical site and along course of brachial plexus – to be assessed. Muscle bulk
of left deltoid and biceps to be compared with right for wasting.
Higher Mental Function / Cranial Nerve Examination
Left Cervical Rib Excision – Post-operative Brachial Plexus Neuropraxia
PATIENT INFORMATION
Name: Mr. Vaibhav Rao (A. Vaibhav Rao)
Age / Sex: 29 years / Male
Address: Ramgarh, Jharkhand
Occupation: Not specified – recreational gym/weight training and motorcycle use reported
Referred by: Dr. Sanjiv Kumar Sharma, Senior Consultant Neurology (MBBS, MD, DM Neurology, AIIMS)
Hand dominance: To be confirmed on assessment
SUBJECTIVE ASSESSMENT
Chief Complaints
• Weakness of left shoulder and elbow
• Decreased grip strength, left hand
• Difficulty performing overhead activities with left arm
• Impaired activities of daily living (ADLs) using left upper limb
History of Present Illness
The patient was apparently asymptomatic until he developed pain in the left little finger while changing gears on a motorcycle.
The pain was initially mild and activity-related; temporary cessation of gym exercises gave slight improvement.
On resuming weight training and upper limb strengthening exercises, he developed progressive numbness of the entire left upper
limb (hand, forearm, and biceps region), associated with swelling, weakness of grip, inability to grasp objects, and pain in the left
shoulder on overhead activity. Symptoms progressively worsened despite occasional analgesics.
MRI of the brachial plexus revealed a 2.1 cm left bony cervical rib compressing the brachial plexus roots (predominantly C7, C8,
T1) – consistent with compressive/entrapment plexopathy. Initial nerve conduction study (NCS) suggested left C6–C7
radiculopathy.
The patient subsequently underwent surgical exploration and excision of the left cervical rib. Intra-operative traction on the
brachial plexus resulted in post-operative neuropraxia, with complete loss of active movement of the left upper limb on post-
operative day 1 (POD-1). Motor recovery began from POD-2. He received one week of in-patient physiotherapy (positioning,
passive ROM, oedema control, breathing exercises, and graded muscle activation), followed by continued out-patient
physiotherapy elsewhere.
Repeat NCS post-surgery demonstrated left axillary and musculocutaneous nerve axonopathy, with slight improvement noted in
axillary nerve function. He now presents for continued rehabilitation.
Past History
• No prior history of similar complaints before the index episode
• Regular gym / weight-training and motorcycle rider
Personal History
To be elicited – diet, sleep, bowel/bladder, addictions.
Family History
Non-contributory (to be confirmed).
Medical History
No known comorbidities reported (e.g., diabetes, hypertension) – to be confirmed.
Surgical History
, Left cervical rib exploration and excision (2026), for left C6–C7 radiculopathy versus left ulnar neuropathy, complicated by intra-
operative traction neuropraxia of the brachial plexus.
Physiotherapy History
• 1 week in-patient PT immediately post-surgery (positioning, PROM, oedema control, breathing exercises, graded activation)
• Continued out-patient PT under another therapist following discharge
Socioeconomic History
To be elicited.
OBJECTIVE ASSESSMENT
Vitals
Temp / PR / BP / RR: to be recorded at the time of assessment.
Observation
• Built of patient: to be assessed
• Position/attitude of limb: guarded posturing of left upper limb, reduced spontaneous use, consistent with recent
axillary/musculocutaneous nerve axonopathy
• Breathing pattern: to be assessed (patient received breathing exercises post-operatively)
• Facial symmetry: grossly symmetric; not clinically implicated
• Deformities / external appliances: nil fixed deformity reported; well-healed left supraclavicular surgical scar (cervical rib
excision site) to be inspected
• Skin: to inspect surgical scar for healing, oedema, or trophic changes over left hand/forearm
• Posture: left shoulder likely depressed/protracted, guarding pattern to be confirmed
• Gait: not expected to be affected – lower limbs uninvolved
Joint-wise Findings
Joint Right Left
Shoulder Normal alignment, full active ROM, no Guarded posturing; reduced active
restriction abduction/flexion, esp. overhead range (to be
measured with goniometry)
Elbow Normal alignment and ROM Reduced active flexion strength (biceps);
ROM to be quantified
Wrist Normal Grossly normal ROM; grip weakness noted
Fingers Normal Weak grasp, reports numbness left little finger;
no fixed deformity
Hip Normal Normal
Knee Normal Normal
Ankle Normal Normal
Subtalar Normal Normal
Toes Normal Normal
Note: precise goniometric ROM and MMT grades to be recorded at bedside; findings above reflect the clinical pattern expected
from axillary and musculocutaneous nerve involvement and should be confirmed on direct examination.
Palpation
Tenderness / local warmth over left supraclavicular surgical site and along course of brachial plexus – to be assessed. Muscle bulk
of left deltoid and biceps to be compared with right for wasting.
Higher Mental Function / Cranial Nerve Examination
