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To all orthopedic experts
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To all orthopedic experts - August 16, 2007 9:54:31 PM
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Ahlecs76
Posts: 33
Joined: March 16, 2005
Status: offline
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that got your attention didn't it! oh well just needed what some of you think about a few things
1. what do you guys think of cervical collars does it really help patients with cervical soft tissue problems? if it does how long do you guys keep it on?
2. pt c spinal stenosis on case load 2 months no improvements with functional tasks. in 2 months PTA only got patient to do sit to stand to handrail. any ideas in treating this patient?
3. 27 y/o female CNA dx with lumbago but presents with more right hip pain than back pain. pt experiencing pain in prone and supine and sidelying on right. seems like not biased to any particular position and that pain is experienced in both flexion and extension. what do you think?
thanks for any kind of input
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RE: To all orthopedic experts - August 17, 2007 7:23:41 AM
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Shill
Posts: 1107
Joined: February 13, 2003
From: Madison WI USA
Status: offline
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1. Sometimes it might be helpful to use a collar for the first week or two after an injury where subtle instability could be an issue, such as MVA. It could be used while sleeping, if there is pain that causes waking with any attempts to change position, or during waking hours if ANY movement causes sharp pain . Beyond that, it is a neck warmer.
2. So the patient has cervical stenosis. So do I. What are the problems this patient has because of the stenosis? Both objective deficit and functional/pain complaints please.
3. You mentioned pt "seems" to not benefit from flexion or extension due to pain with both. Is this pain during or pain as a result of the movement? This is what matters with testing repeated movements. It is important to not go on how things seem, but rather how things ARE, meaning that you need to do the repeated movement testing in 3-5 sets of 10 reps, before drawing conclusions as to whether the movement helps, hinders, or centralizes symptoms as a result of the movement. There are many variations on extension, including with or without a shift, with or without concomittant lumbar mobilization, standing, prone, etc, etc, the list goes on. Not until you exhaust all of these should you decide that they have no directional preference.
So, thats my three cents. Have a nice weekend.
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RE: To all orthopedic experts - August 17, 2007 7:55:21 AM
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jesspt
Posts: 88
Joined: April 3, 2007
From: Illinois
Status: offline
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1. From what I've seen, cervical collars to a great job of enforcing fear-avoidance beliefs and encouraging avoidance of movement. I try to get my patinets off of them ASAP.
2. Agree with Shill - I need more objective info.
3.Have you performed repeated motions testing as Shill described? Also, how long ago was she injured? Did you do any provocation testing on the hip?
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