Dear Patrick and John
Thank you very much for your kind and quick reply.
----- Original Message -----
??? : "Patrick Zerr" <[log in to unmask]>
?? : <[log in to unmask]>
???? : 2002?9?19? 23:08
?? : Re: Whiplash patient with headache
> Dear Hiro:
>
> The + MRI is of concern. Why is it old? does she have degenerative
changes
> that are associated with it indicating it to be old?
I might make a mistake.
The orthopaedist said probably there might be no problem in the "lumbar
spine".
He didn't mention cervical MRI had no problem.
I didn't and couldn't check her cervical osteophytes as the films of X-P and
MRI were in another hospital.
>Does she have
> osteophytes that may be impinging nerve roots or possibly vert. artery?
> Nauseau and vomitting warrant caution. You did not say if you tested Vert
> artery?
I have never taken upper cervical course.And then I thought I was not
competent
to try it,though I could learn it from Maitland's "Vertebral Manipulation".
>
> It is impossible to say whether to mobilize specifically with your
> description. It sounds like she needs extension though because she has
pain
> getting into it and can't lay supine which requires it.
She could lie on back but it cannot alleviate her symptoms.
>
> Interesting case. Let us know how it goes.
Thank you for your helpful message.
Best regards,
Hiro Wood
PT BA
Japan
----- Original Message -----
??? : "John Cumberbirch" <[log in to unmask]>
?? : "Hiro Wood" <[log in to unmask]>
???? : 2002?9?20? 15:32
?? : Re: Whiplash patient with headache
>
> Dear Hiro;
>
> Somethings to include in your assessment:
> I agree with one contributor who noted that you had not checked for
> vertebral artery compromise. Indeed, if arthrokinematics (joint glide
> excursion/nature) is abherrant, some traction may be put on the artery.
>
> Secondly, I did not note any stability tests performed. These would
> include alar ligament tests and transverse ligament as well as A/P's and
> laterals of upper 3 vertebrae.
>
> I would also contemplate that there might be a coexistence of phenomena.
> ie. Maybe the 'old' C5/6 problem continues or is resurrected as well as a
> vertebral artery response with or without a problem with osteokinematics
> (physiological or natural movement of one bone in space) due to
> ligamentous disruption.
I am puzzeled in that all of replies I received mention C5-6 disk
hernia,though
neurological sign is normal.(C5-6 area).I cannot understand why all of you
care
about C5-6 disk hernia.I don't think C5-6 problem cause her headache---her
biggest problem.So I have been thinking of only upper cervical problem.
>I would not do traction without ensuring
> stability of segments. Were there any difficulties with speech,
> swallowing, double vision, etc...?
>
I felt she rolled her r's but I didn't check it precisely.Next time I will
do it.
This case may be beyond of my competency until I take an upper cervical
course.
Best regards,
Hiro Wood
Japan
> ----- Original Message -----
> From: "Hiro Wood" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Thursday, September 19, 2002 5:33 AM
> Subject: Whiplash patient with headache
>
>
> > Hello world!
> > Could anyone kindly give me an advice?
> > Here is a patient's profile.(nurse)
> > 1.age 41
> > 2.History
> > 10 Aug.2002 When she was riding in a front seat next to driver seat,
> > her car was rammed from the right front side twice by different cars
> > in turn.Then she went to an emergency hospital and was advised to be
> > admitted in the hospital.But she refused it to say that she couldn't
> > take a rest from her work.(There indeed are many dutiful person
> > in Japan who don't care about her body.I can hardly understand it.)
> > The next day of the accident,she went to work and had been working
> > as usual with medication until recently,suffering from headache.
> > 1 week after the accident,symptoms came out.
> > On 31 Aug.dizziness and vomitting.
> > 3 Sept.she finally could come to begine half day work.
> > She has no hitory of RA.
> > 3.Symptom
> > Headache,feeling as heavy weight on her head.
> > Dysesthesia in both hand.
> > No change compared to the onset(1 week after the accident).
> > 4.Pain
> > neck and shoulder
> > tenderness in thoracic (T4 to T7) spine
> > 5.Neurological sign
> > normal(reflex,muscle power,sensation)
> > 6.Active ROM
> > cervical Flex 60 --- no disability in face washing
> > Ext 40 --- pain(+)
> > SB (r) 25 (l) 35
> > Rot.(r) 75 (l) 75
> > 7.Posture
> > There may be a decrease(?) in cervical lordosis as I could palpate
> > the C6 spinous process.
> > A slight chin deviation(?) in the right.I haven't full confidence
though.
> > 8.Spinal motion
> > 1)Sub-cranial BB(Backward Bend)
> > decrease of smoothness in motion and ROM
> > no increase of deviation of chin in motion
> > 2)Occiput SB
> > decrease of smoothness and ROM in SB(l)
> > 3)Neck FB
> > There may be a little decrease of smoothness in first
> > movement-- nodding.
> > But this may be due to preconception of mine.
> > 4)Neck SB
> > Headache by gentle overpressure at the end feel of SB(r)
> > 5)Neck and head Rot.
> > decrease of smoothness in Rot.(l).Then there may be a slight BB.
> > 6)Rot of upper thoracic
> > I couldn't feel the movement of T2,T3.
> > This may be owing to the lack(short) of full ROM.
> > 9.Radiologic data
> > 1)Head CT -- intact(same meaning as normal?)
> > 2)Cervical MRI -- disk hernia in C5-6
> > Orthopedist said it would not be new one.
> > 3)Open mouth X-P was not taken.
> > 10.Diagnosis by orthopedist
> > cervical and lumbar strain
> > 11.Treatment history of after injury
> > Accupuncture and hot pack.They are effective temporarilly.
> > Cervical traction made her worse.
> > 12.Aggravating factor
> > standing during 4 to 5 hours for her work.Headache and paresthesia
> > of the hands get worse at that time.
> > 13.Alleviating factor
> > none.Even if she lies on back,no change in her symptom.This is
> > very miserable(poor?)
> > 14.Headache
> > no change by coughing,sneeze and straining.
> > 15.Interpretation
> > 1)Chin deviation to slightly right may indicate(mean) the dysfunction
> > of A-O joint.
> > 2)The decrease of smoothmess in occiput SB(l) may indicate the
> > dysfunction left(?) A-O joint.
> > 3)The headache in gentle overpressure for the end feel of neck SB(r)
> > may indicate the dysfunction of A-O joint.
> > 4)The decrease of smoothness in neck Rot(l) may indicate the
> > dysfunction of A-A joint.
> > 16.My treatment(1st.day)
> > I told her the result of my examination as below.
> > I suspected the dysfunction of upper cervical spine,especially
> > A-O joint.
> > I wanted her to get cervical open-mouth X-ray and should be checked
> > by an orthopedist.
> > 17.Question
> > 1)What should I do next?Should I say to her that I am not competent
> > to treat her untill I take an upper cercical course?
> > Or can I treat her with studying some books by myself?
> > 2)Is it better that I will make her get upper cevical CT,if possible?
> > There is a CT equipment in her hospital.
> > I asked a radiologist in my hospital about whiplash and CT today.
> > He said MRI would be better for upper cervical but the fracture of
> > it could never happen in whiplash.
> >
> >
> > I am going to implement manual traction and C3 downward and upward
> > mobilization for now.Is it correct?
> > Thanks in advance.(Yorosiku onegai simasu.)
> >
> > Hiro
> >
>
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