Cervical Case 1
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Cervical Case 4Subjective Examination A forty-two year old woman attended four days after suffering from a rear end collision. She was driving the car that was rear-ended and which was moving forward at the time of the accident. She was hit directly in the rear, her head was facing forward and she was aware of the impending impact and so braced herself against the wheel with her arms. She did not hit her head nor did she loose consciousness and did not suffer from any amnesia. She felt some mild neck pain at the time of the accident but this was worse the next day on waking. The pain was felt in mid to lower cervical spine with radiation to the right upper trapezius. She did not complain of headaches, dizziness or paresthesia. The pain was felt to level off that same day and was described by the patient as moderate reaching a level of 5 on a 1 to 10 scale. In addition to the posterior cervical pain there was very mild pain in the left anterior mid-cervical area. There had been no change in the pain since this time. She was still working as a high school teacher. The pain tended to be a little worse at the end of the day and better in the morning. She had no trouble sleeping. The patient had no past history of neck or arm pains and no medical history of relevance. From her history, what is her likely prognosis? Discuss how you would continue her examination and what results you expect. Turn to page Cervical Case 4 Discussion There are number of indicators that this patient should have a good prognosis.
Despite the good prognosis, it is best to approach cervical trauma carefully. There is still the possibility of vertebral artery damage. One study using magnetic resonance angiography demonstrated that one in ten whiplash victims may have damaged one artery and be either asymptomatic or have minimal symptoms. I would suggest the sequence outlined on page ??? be followed for all traumatic necks regardless of how minor the damage appears to be. The examination is not overly long and goes a little further to ensure the safety of this higher risk patient. Objective Examination There was nothing of note on observation and the fracture and cranial nerve tests were negative and there were no signs of spinal nerve or nerve root involvement. Craniovertebral ligament stress testing was negative and the dizziness tests (vertebral artery tests) were unremarkable. Cervical range of motion was as follows. Extension was about 80% of the expected range and reproduced posterior neck pain. Flexion was full range and painless. Both rotations were about 80 degrees with pain felt on the opposite side of the posterior neck and both side flexions reached about 30 degrees and produced mild pain ipsilaterally. In addition, left rotation caused some very mild left anterior neck pain. Compression and traction were negative while isometric right rotation caused mild left anterior neck pain. Postero-anterior pressures over C5 and C6 produced mild central discomfort. Biomechanical assessment found that extension at both C5/6 zygopophyseal joints was restricted with a minor spasm end feel. What is your diagnosis and treatment? Have you changed your prognosis? Turn to Cervical Case 4 Discussion Diagnosis This lady appears to be suffering from a mild posttraumatic arthritis of the lower cervical region probably C5/6. There may be some underlying biomechanical dysfunction but it may not be possible to assess this until the inflammation has resolved. From the isometric tests, there also seems to be a minor injury to the left sternomastoid, palpation along its length will confirm and localize the lesion. Treatment The patient should be instructed to do nothing that reproduces the pain as this will retard the resolution of the inflammatory processes. As she seems to functioning well, the need for a collar is debatable and I would try to avoid this if possible. However, there is a little worsening at the end of the working day and if this continued or if there was failure to improve with treatment, a hard collar for work for a few days or alternately a week off work might be indicated. Otherwise treatment can be reasonably aggressive providing the patient's symptoms are not brought on by the treatment. Anti-inflammatory modalities such as ultrasound and interferrential currents aimed at the C5/6 segment region can be applied but it is not likely to have a dramatic effect given the low level of inflammation present. Exercises both for the neck and for the segment (segmental PNF) should help maintain muscle co-ordination while the inflammation resolves. In this case, it was necessary to manipulate or mobilize the right zygopophyseal joint into flexion once the inflammation had resolved. The sternomastoid injury would almost certainly have resolved itself but ultrasound applied over the injured area probably speeded things up. The minor range of motion loss in the neck and the absence of neurological signs, strengthens the good prognosis. This patient became painfree in two weeks with six treatments. Directory: cgi-bin cgi-bin -> Terry L. Root cgi-bin -> Rochester, ny 14620 585-395-2587 (work), 585-423-9603 (cell) cgi-bin -> Online Edition Newsletter of the North American Sport Library Network cgi-bin -> 2009 Master of Ceremonies: Allen Weiner cgi-bin -> Are There Any Who Are Wise? September 12, 2010 cgi-bin -> Job profile cgi-bin -> Position description cgi-bin -> 3030 Rev 06/2009 NonCompliance Tracking System cgi-bin -> Ruoff Place of Birth: Long Beach, California, U. S. A. Citizenship Download 117.42 Kb. Share with your friends:
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