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 Paris S3 course note 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
