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Abstract
A 41-year-old man presented in general practice with neck and back pain. Assessment showed somatic dysfunction in the cervical spine and thoracic outlet, and concurrent issues arising from orchidectomy including psychosocial problems which might determine a poor prognosis. Management included manual therapy to the symptomatic area, co-ordination of specialist services and counselling against his catastrophisation and helplessness. The interim outcome was of pain relief and a more positive attitude to planning his life-style and potential for work.