Pain in the neck and arm: a multicentre trial of the effects of physiotherapy, arranged by the British Association of Physical Medicine.
Authors: D Brewerton, P Nichols, Mr Logue, D Mason, P Pnewel, A Beardwel, P Blower, Ml Brown, P Campbell, G Coohra, A Corripgn, A Bade, A Featherby ', E Hamilton, W Hayley, El El Ibiara, J Jeop, P Hume, Kdi Knight, -B Laam, P Nicho, K Nixon, T Spurr
Journal: BMJ (1966)

The British Association of Physical Medicine is planning to Though fulfilling these criteria the follo carry out a series of multicentre trials of physical treatments.excluded from the trial:The present paper is a report of the first trial, which was devoted 1. Patients in whom the symptoms were to the conservative management of pain in tle upper limb to local lesions such as cervicalrib, rotate believed to arise within the neck.This syndrome was chosen shoulder, tennis-elbow, or a carpal-tunnel sy] because it is very common and often treated by physical 2. Patients who had definitive disorders methods, though with little evidence of their value.Further- such as-rheumatoid arthritis or Paget's di, more, it has been the subject of a preliminary -studf (Steinberg bony injury to the cervical spine in the prec and Mason, 1959).3. Patients with abnormal neurological s An advisory committee1 was set up to plan the trial, and nine compression.London hospitals' agreed to take part.4. Patients currently being treated phenylbutazone.Selewtion of CasesThough the syndrome investigated is commonly thought to be due to root-compression secondary to degenerative changes Recording.-Adetailed questionary w within the cervical spine, the Committee acknowledged from covered the history and clinical examir the outset that not all authorities agree that this is the cause, attendance, a follow-up at two weeks, and and believed it would be impossible to select patients on the four weeks.This was completed by the ph3 basis of a precise diagnosis of-this kind.The Committee there- of treatment were included in an additionu fore defined a symptom-omple and agreed to include some pleted by the physiotherapst.Folowpatients with clinically normal necks provided they had full questionaries from the coording centre root-symptoms and others with partial root-symptoms providedmonths.Altogether 140 questions an& ans they had definite clinical abnormality in the neck.The abence, for each patient.of abnormAl neurological signs did not exclude patients from thle trial..,., Clinical Exarmination.-Neckmovementz the nearest five degrees.To aid the assessn Patients were selected from those attending departments of movement doctors taking part were advise physical medicine, and whea admitted to the trial had to hammer on the patient's head, either on thi comply with one of the following sets-of criteria: extension, and lateral lion? or on the fc 1. Pain in the neck and arm (with or without paraesthesiie), (see Fig. 1).A preliminary observer-err the symptoms having a root distribution and being associated with limited and painful movements of the neck.2. Pain in the neck and arm of full root-distribution with paraesthesiae but without clinical evidence of abnormality in the neck.Pain or parnesthesiae mi the neck and arm of partial rootdistribution but with definite evidence of clinical ity in in the neck.