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 http://www.medscape.com/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