I love a challenge and this gentleman is certainly a case in point!
I saw this gentleman recently and devised a functional strengthening program for him as well as manual therapy techniques for his neck and upper thoracic spine. His xray below illustrates a deviation of over 35 degrees and the bottom cervical vertebra have fused. Note in the photo the atrophy (wasting) of his left shoulder muscles compared to the right side. I have devised a program to improve the strength in his shoulder, neck and thoracic spine.