Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 133

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“Clinical Protocols & Case Study”


Disclaimer: These are Dr. McCain’s personal protocols and are intended to give you an insight into his thought process in treating patients.  You must make your own clinical decisions based upon the clinical presentation of your individual patients.

 

Author:

Dr. Brian S. McCain is a 1999 graduate of Logan Chiropractic College.  He is currently the director of Adams County Spine & Accident Center in Westminster, CO, a multi-disciplinary center with specialty care that ranges from chiropractic to neurology and functional medicine.

 

- History: 49 year old male with acute episode of neck pain and sharp pain radiating from the neck into the left shoulder.  He said that he was involved in a motor vehicle collision two days prior. He was the driver of his vehicle and struck another vehicle in an intersection. The other vehicle was running a red light.  He said that he started to feel pain later after the accident while he was at the emergency room.  X-rays were taken at the hospital (cervical lateral and APOM).

- He is also experiencing numbness in his left hand and fingers. Although mild, it is most noticeable at night when he is trying to sleep.           

- He was discharged from the hospital with Vicodin for pain and Skelaxin for a muscle relaxer and instructed to follow up with his physician.

 

- Examination: A comprehensive examination was performed which included vitals, complete medical history, review of systems, and musculoskeletal evaluation.  Range of motion in the cervical spine was restricted with pain in extension and right lateral bending.  He reported headache on the right temporal area; 4 out of 10 pain scale.

 

- Foraminal compression, Jackson’s, Foraminal distraction and shoulder depressor were all positive.  There was radicular hypoesthesia over the C6 dermatome on the left during pinwheel evaluation.  Grade 4/5 muscle weakness in the left deltoid muscles.

 

- A Davis radiographic series of the cervical spine was also performed, the obliques were necessary to rule out contraindications to osseous spinal adjustments/manipulations.  Stress views were needed to determine motion segment integrity.  There were abnormal findings in angular variation (12.5°) which indicates hypermobility and ligament laxity, a ratable 25% impairment in accordance with AMA guides 5th Edition.

 

- The patient was treated for one week with low-volt muscle therapy, hot and cold compresses, and ultrasound.  After one week, a cervical MRI was ordered. It was another week before the MRI was approved and the patient was able to schedule, so the MRI was finally taken twenty days after the reported incident.

 

- Cervical MRI revealed a central disc herniation at C3/C4 that slightly contacted the ventral aspect of the cord.  There was a C5/6 left paracentral herniation that caused mild foraminal narrowing and contact with the exiting nerve root.  T1 & T2 axial and sagittal slices were 3mm with 2mm gap.

 

- At four weeks post accident, numbness was persistent in the left hand and fingers.  Then an EMG/NCV of the upper extremities was ordered.  No radiculopathy or myopathy was diagnosed. There was evidence of bilateral mononeuropathies at the wrists, mild in severity, consistent with carpal tunnel syndrome.

 

- Treatment plan after the MRI was performed changed to 4 times over two weeks of axial decompression/distraction, therapeutic procedures to improve range of motion, muscle strength and facilitate healing to the injured tissues.  This treatment plan continued 3 times per week for another 4 weeks. Then the patient was placed on 1 time per week for another 4 weeks before being released from care.

 

- Diagnosis:

Cervical Radiculitis 723.4

Cervical Intervertebral Disc Herniation w/o myelopathy 722.0

Ligament Laxity 728.4

Dislocation, Subluxation; closed, due to injury of sixth cervical vertebra 839.06

Paresthesia 782.0

Cervical Segmental Dysfunction 739.1

Carpal Tunnel Syndrome 354.0

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