Transcript Case Presentation Orthopedics and Neurology

Orthopedics and Neurology
Case Presentation
Whiplash Type Injury
James J. Lehman, DC, MBA, DABCO
University of Bridgeport College of Chiropractic
Lab Assignment
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Listen to history and report of findings
Take notes
Answer questions
Write SOAP notes for this patient
Whiplash Type Injury
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32 year-old female
Driver
Rear-ended one-year
ago
Good health
No prior injuries
2 children (4 & 7 Y/O)
Symptomotology
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Neck pain
Headaches
Weak neck
Tingling in fingers
Insomnia
History
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Closed-ended
Open-ended
OPQRST
ADL
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Police report
Medical records
Activities of Daily Living
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Work
Childcare
Marital relations
Exercise
Objective Findings
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Reduced CAROM,
PROM, and RROM
with extension, RLF,
and RROT with pain
at C4-5-6-7
Sensory Findings
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Hypesthesia (pain
with pin prick and light
touch with wisp of
cotton)bilaterally at
thumb, index, third
finger
Motor Findings
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Biceps, wrist
extension and flexion
4/5 bilaterally
Remainder of brachial
plexus 5/5 bilaterally
Grip strength reduced
bilaterally
Deep Tendon Reflexes
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All upper and lower
extremity DTR’s are
2+ bilaterally and
brisk except
brachioradialis
1+ right
2+ sluggish left
Pathologic Reflexes
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Absent for signs of
Babinski, toe
extensor, and
Hoffmann’s sign
History of Babinski
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http://www.medscape.
com/viewarticle/4477
85_2
Superficial Abdominal Reflex
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Beevor’s Sign absent
Present in all four
quadrants
Imaging Studies
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Rule out
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Fracture
Subluxation
Dislocation
Pathologies
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DJD
DDD
Radiology Report
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What do you think the
radiologist diagnosed
with this patient from
this neutral, lateral
view of the cervical
spine?
Why?
Differential Diagnosis
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How to differentiate
strain from sprain…
Trauma to Cervical Spine
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Tearing of disc C5-6-7
 What is your DX?
Diagnostic Imaging
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Diagnostic imaging
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Initial
Follow-up