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Re: cervical spine HNP
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Re: cervical spine HNP - September 15, 2004 4:43:00 AM
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eam
Posts: 292
Joined: February 5, 2004
From: New York, NY 10028
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Hi again-
I forgot to mention in my last post that the docotr also suggested acupuncture to the patient. Erica
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Re: cervical spine HNP - September 15, 2004 11:50:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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have you checked her for stbaility at C5-T3? Doing similar to MMT but holding and looking for more of a fatiguing issue going on, weismantel kind of stuff?
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Re: cervical spine HNP - September 16, 2004 6:08:00 PM
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eam
Posts: 292
Joined: February 5, 2004
From: New York, NY 10028
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I am not totally familiar with the Weismantel type stuff but I did find a few FRS (R)'s on her mid-cervical spine today. Treated them and she had an increase in pain free extension and almost full FB. Actually, today she said that this was the best she has felt in a while. Hope fully that lasts! But we have alot of work to do still. I don't know if there will be carryover on to the next visit, we'll see. I think this is going to be a long haul.
Erica
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Re: cervical spine HNP - September 25, 2004 5:07:00 PM
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eam
Posts: 292
Joined: February 5, 2004
From: New York, NY 10028
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Hi everyone-
Just an update. My patient went to the neurosurgeon a few days ago. According to him, she is not a surgical candidate at this point. Her age being the predominating influence-she is only 24 yrs old. He felt that although she is "not out of the woods" yet she is on the right track. Told her to continue PT etc. I have been telling her to wean herself off the soft collar at night. The physiatrist actually told her to wear it more!
The neuro-surgeon did flexion/extension xrays. In a nutshell, she has minimal cervical lordosis at this point-he told her to get off that collar soon- and while she was holding the so called "extension" moment for the xray-like 30 seconds-she had killer pain right down to T6. With the flexion part-he told her that although she was able to flex forward there was very little flexion occuring at the cervical spine.
ColoradoJulie-You mentioned that I should try passive extension just to try and keep some extension "alive". I have been able to perform PROM extension to full range but only coupled with rotation and SB away from the painful side. I figure at least that helps-she can get there pain free. In the short term I will take it.
It is tough to explain or validate some of this but I feel that any movement at this point is a good thing for her.
The neuro-surgeon agreed that there was no instability, fx etc. Her HA should diminish over time-and they have.
I have been sticking to my MET techniques so far. I just read an article in JOSPT on whiplash and thoracic spine mobilization. Has anyone else read it?
Thought I would just give everyone an update. Thanks again for the posts. Any other thoughts would be appreciated.
Erica
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Re: cervical spine HNP - September 25, 2004 5:56:00 PM
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MPT
Posts: 161
Joined: April 4, 2004
From: Syracuse, New York
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Sounds like a mess. I did not read the whole thread so if this has been mentioned already I apologize. It is not uncommon for an MVA patient to have torn an alar ligament. I know she had an MRI but I often wonder if radiologist are good at spotting this.
It would also be interesting to look at her eye tracking. Often post MVA pt will have difficulty tracking in one direction (laterally). Sometimes working on this can help with overall recovery. It is also just an interesting finding.
Good luck
Krakenes J, Kaale BR, Moen G, et al. MRI assessment of the alar ligaments in the late stage of whiplash injury--a study of
structural abnormalities and observer agreement. Neuroradiology 2002;44:617-24.
Urso S, Pacciani E, Ascani E, et al. [Static-dynamic computerized tomography in the diagnosis of traumatic lesions of alar ligaments.
Preliminary results]. Radiol Med (Torino) 1994;88:736-41.
_____________________________
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Re: cervical spine HNP - September 26, 2004 5:01:00 AM
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SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
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Yes, Erica,
That article is interesting. The low frequency of PT visits throughout that duration of time with the outcome achieved is thought provoking for me. From an outcome perspective, I believe it brings up the question of medical necessity with a high frequency of PT visits.
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Re: cervical spine HNP - September 26, 2004 6:33:00 AM
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eam
Posts: 292
Joined: February 5, 2004
From: New York, NY 10028
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SJBird-
My thoughts exactly. After reading the article, my thoughts were that very little "treatment" was given. I have to re-read the article, but I am assuming they eventually did a thorough evaluation of the c-spine. This all begs the question of how much treatment is necessary? This was just one case report, but interesting, nonetheless. And furthermore, do we always treat what we find? (in terms of dysfunction etc) Thought provoking indeed....
Erica
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