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?  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?

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.

Interesting case.  Let us know how it goes.
Patrick Zerr
www.apluspt.com
The easiest way to prepare for the National PT Exam!
www.summitpt.com
Summit Physical Therapy; Tempe, Arizona


----- 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 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
>