Case Presentation Orthopedics and Neurology案例演示骨科和神经.ppt

Orthopedics and Neurology Case Presentation  Whiplash Type Injury James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic Lab Assignment Listen to history and report of findings Take notes Answer questions Write SOAP notes for this patient Whiplash Type Injury 32 year-old female Driver Rear-ended one-year ago Good health No prior injuries 2 children (4 7 Y/O) Symptomotology Neck pain Headaches Weak neck Tingling in fingers Insomnia History Closed-ended Open-ended OPQRST ADL Police report Medical records Activities of Daily Living Work Childcare Marital relations Exercise Objective Findings Reduced CAROM, PROM, and RROM with extension, RLF, and RROT with pain at C4-5-6-7 Sensory Findings Hypesthesia (pain with pin prick and light touch with wisp of cotton)bilaterally at thumb, index, third finger Motor Findings Biceps, wrist extension and flexion 4/5 bilaterally Remainder of brachial plexus 5/5 bilaterally Grip strength reduced bilaterally Deep Tendon Reflexes All upper and lower extremity DTR’s are 2+ bilaterally and brisk except brachioradialis 1+ right 2+ sluggish left Pathologic Reflexes Absent for signs of Babinski, toe extensor, and Hoffmann’s sign History of Babinski /viewarticle/447785_2 Superficial Abdominal Reflex Beevor’s Sign absent Present in all four quadrants Imaging Studies Rule out Fracture Subluxation Dislocation Pathologies DJD DDD Radiology Report What do you think the radiologist diagnosed with this patient from this neutral, lateral view of the cervical spine? Why? Differential Diagnosis How to differentiate strain from sprain… Trauma to Cervical Spine Tearing of disc C5-6-7 What is your DX? Diagnostic Imaging Diagnostic imaging Initial Follow-up * * *