Guest guest Posted June 24, 2010 Report Share Posted June 24, 2010 Have your imaging center do a specific upper cervical MRI sequence. Either Bridgeport or EPIC will do a nice job. EPIC or Siker Imaging both have 3T scanners. IN addition, both will do motion MRI, and EPIC has the Fonar. In office, you want to do a flexion/extension plane film to look for ADI abnormality, and lateral bending open mouth to look for overhang/movement. Don White, RN, DC In a message dated 6/24/2010 11:54:18 A.M. Pacific Daylight Time, drbobdc83@... writes: Hey gang, Just examined a MVC patient who saw "bright lights" and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2010 Report Share Posted June 24, 2010 , Others will have good advice re the MRI....but, bright lights suggest/imply a sublux of the occiput.....it could have already been present (assuming the guy, like most guys inour society (before degeneration) are a category II/si syndrome) torqued with the impact torquing enough more to 'flash' the optic nerves. Getting his cranium adjuted could change that whole life again. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com From: drbobdc83@...Date: Thu, 24 Jun 2010 11:53:34 -0700Subject: Alar Ligament Hey gang, Just examined a MVC patient who saw "bright lights" and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2010 Report Share Posted June 24, 2010 I would go with Siker Medical. I had am MRI for Alar Ligament injury and they did a fabulous job. You want to order a Cranial-cervical Krakenes study. My study came out neg. These guys are the pro's. Schneider DC On Thu, Jun 24, 2010 at 11:53 AM, M. s, D.C. <drbobdc83@...> wrote: Hey gang, Just examined a MVC patient who saw " bright lights " and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. -- Schneider DC PDX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2010 Report Share Posted June 24, 2010 You also can take a vertex x-ray view along with lateral open mouth. Larger gap side is the damage side. You may also want to contact Dr. Mike Underhill for a DMX. If positive there are exercise specific to help the cervical muscles to stabilize the neck.    Carl Bonofiglio, D.C. Wellness Consultant 503-608-7484 www.spinalquest.net -- Re: Alar Ligament I would go with Siker Medical. I had am MRI for Alar Ligament injury and they did a fabulous job. You want to order a Cranial-cervical Krakenes study. My study came out neg. These guys are the pro's. Schneider DC On Thu, Jun 24, 2010 at 11:53 AM, M. s, D.C. <drbobdc83charter (DOT) net> wrote: Hey gang, Just examined a MVC patient who saw "bright lights" and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. -- Schneider DC PDX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2010 Report Share Posted June 25, 2010 Dear : I think a simple test for the alar ligament is to touch the posterior spinous of C2 and the mastoid on the right and very lightly ( lighter than you think is light) distract and compress. Then test between C2 and left mastoid. When the alar ligament is ruptured or C1 is rotated there will be significant laxity noted. An other complications in this area is that C2 can tilt posteriorly and the dens can be position to irritate the dura. As I am learning in neurology class it can also cause harm to directly correct these problems without attending to visual and cerebellar problems that are caused by an injury of this sort. Sincerely, Judith Boothby Alar Ligament Posted by: " M. s, D.C. " drbobdc83@... Thu Jun 24, 2010 11:53 am (PDT) Hey gang, Just examined a MVC patient who saw " bright lights " and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. Back to top Reply to sender | Reply to group | Reply via web post Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2010 Report Share Posted June 25, 2010 In addition a very simple first step is to expose AP Open-Mouth Odontoid lateral bending stress views and look for translation of the atlas on the axis and if present the contralateral alar ligament has been torn. Only if the translation in the frontal plane is over 1 mm would I suggest going through the time and expense of a cranialcervical MRI with Karekens (sp?) protocol. Then if the translation is 3mm or more it is very useful to gain a DMX of the defect as it is very good demonstrative evidence of the injury for the jurors if the case is headed to trial… Vern Saboe From: [mailto: ] On Behalf Of Boothby Judith Sent: Friday, June 25, 2010 9:56 AM Cc: boothbyj@... Subject: Alar Ligament Dear : I think a simple test for the alar ligament is to touch the posterior spinous of C2 and the mastoid on the right and very lightly ( lighter than you think is light) distract and compress. Then test between C2 and left mastoid. When the alar ligament is ruptured or C1 is rotated there will be significant laxity noted. An other complications in this area is that C2 can tilt posteriorly and the dens can be position to irritate the dura. As I am learning in neurology class it can also cause harm to directly correct these problems without attending to visual and cerebellar problems that are caused by an injury of this sort. Sincerely, Judith Boothby Alar Ligament Posted by: " M. s, D.C. " drbobdc83@... Thu Jun 24, 2010 11:53 am (PDT) Hey gang, Just examined a MVC patient who saw " bright lights " and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. Back to top Reply to sender | Reply to group | Reply via web post No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.439 / Virus Database: 271.1.1/2960 - Release Date: 06/25/10 06:35:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2010 Report Share Posted June 25, 2010 I'm curious Vern, we were taught back in the day that APOM + lateral bending views were highly prone to positioning errors, and as a result no normative data had yet to be generated to make those claims hold water in a med-legal environment. Have those normative data studies been performed in the last few years. Video fluoroscopy held a lot of promise on this too, but seems to be less in use these days. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember, American College of Sports MedicineAssoc. Member, International Society of Clinical Rehabilitation Specialistsboothbyj@...; From: vsaboe@...Date: Fri, 25 Jun 2010 10:39:35 -0700Subject: RE: Alar Ligament In addition a very simple first step is to expose AP Open-Mouth Odontoid lateral bending stress views and look for translation of the atlas on the axis and if present the contralateral alar ligament has been torn. Only if the translation in the frontal plane is over 1 mm would I suggest going through the time and expense of a cranialcervical MRI with Karekens (sp?) protocol. Then if the translation is 3mm or more it is very useful to gain a DMX of the defect as it is very good demonstrative evidence of the injury for the jurors if the case is headed to trial… Vern Saboe From: [mailto: ] On Behalf Of Boothby Judith Sent: Friday, June 25, 2010 9:56 AM Cc: boothbyj Subject: Alar Ligament Dear : I think a simple test for the alar ligament is to touch the posterior spinous of C2 and the mastoid on the right and very lightly ( lighter than you think is light) distract and compress. Then test between C2 and left mastoid. When the alar ligament is ruptured or C1 is rotated there will be significant laxity noted. An other complications in this area is that C2 can tilt posteriorly and the dens can be position to irritate the dura. As I am learning in neurology class it can also cause harm to directly correct these problems without attending to visual and cerebellar problems that are caused by an injury of this sort. Sincerely, Judith Boothby Alar Ligament Posted by: " M. s, D.C." drbobdc83charter (DOT) net Thu Jun 24, 2010 11:53 am (PDT) Hey gang, Just examined a MVC patient who saw "bright lights" and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. Back to top Reply to sender | Reply to group | Reply via web post No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.439 / Virus Database: 271.1.1/2960 - Release Date: 06/25/10 06:35:00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2010 Report Share Posted June 25, 2010 Hi , Good questions. I know of no “normative values” for APOM with lateral bending. Everyone is working off the body of literature that refers to any translation in the sagittal plane over 1 mm being clinically significant as per the cervical motion segments and 3.5 or greater a class II ligamentous injury and “loss of motion segment integrity” (AMA Guides 5th Ed) with the 6th eliminating this term and mm for a percentage. So we are applying this concept to the frontal plane with the APOM lateral bending stress views which is well referred to in the medical literature no “normative values” per say but the clinical concept that any translation over 1 mm maybe clinically significant and anything over 3.5 mm absolutely significant. What I have found in my experience is that when I see translation of the atlas at 3mm or greater there will always be a positive MRI as per revealing a alar ligment tear. Further, a DMX is of little use as per demonstrating the defect if it is less than 3 mm and extremely impactful if over 3 mm into the range of 5 mm or even greater…..all of which has a clinical nexus to the patient’s mechanisms of injury (e.g., rear-impact with head turned) and presenting symptoms suboccipital neck pain and headache etc….. Vern From: Snell [mailto:drpsnell@...] Sent: Friday, June 25, 2010 11:19 AM vsaboe@...; boothbyj@...; oregon dc listserve Subject: RE: Alar Ligament I'm curious Vern, we were taught back in the day that APOM + lateral bending views were highly prone to positioning errors, and as a result no normative data had yet to be generated to make those claims hold water in a med-legal environment. Have those normative data studies been performed in the last few years. Video fluoroscopy held a lot of promise on this too, but seems to be less in use these days. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.com www.fixyourownback.com Member, American College of Sports Medicine Assoc. Member, International Society of Clinical Rehabilitation Specialists To: boothbyj@...; From: vsaboe@... Date: Fri, 25 Jun 2010 10:39:35 -0700 Subject: RE: Alar Ligament In addition a very simple first step is to expose AP Open-Mouth Odontoid lateral bending stress views and look for translation of the atlas on the axis and if present the contralateral alar ligament has been torn. Only if the translation in the frontal plane is over 1 mm would I suggest going through the time and expense of a cranialcervical MRI with Karekens (sp?) protocol. Then if the translation is 3mm or more it is very useful to gain a DMX of the defect as it is very good demonstrative evidence of the injury for the jurors if the case is headed to trial… Vern Saboe From: [mailto: ] On Behalf Of Boothby Judith Sent: Friday, June 25, 2010 9:56 AM Cc: boothbyj@... Subject: Alar Ligament Dear : I think a simple test for the alar ligament is to touch the posterior spinous of C2 and the mastoid on the right and very lightly ( lighter than you think is light) distract and compress. Then test between C2 and left mastoid. When the alar ligament is ruptured or C1 is rotated there will be significant laxity noted. An other complications in this area is that C2 can tilt posteriorly and the dens can be position to irritate the dura. As I am learning in neurology class it can also cause harm to directly correct these problems without attending to visual and cerebellar problems that are caused by an injury of this sort. Sincerely, Judith Boothby Alar Ligament Posted by: " M. s, D.C. " drbobdc83@... Thu Jun 24, 2010 11:53 am (PDT) Hey gang, Just examined a MVC patient who saw " bright lights " and passed out momentarily after he was hit from behind in Dec of '09. Ever since, he's had chronic headaches, malaise, moodiness, whole life is changing... Suspicious of significant upper cervical ligament injury, wanting to know how to DX Alar ligament injury (i.e. plain MRI or does the ligament have to be injected or does it have to be motion MRI???). Thanks! (:-) M. s, D.C. Back to top Reply to sender | Reply to group | Reply via web post No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.439 / Virus Database: 271.1.1/2960 - Release Date: 06/25/10 06:35:00 No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.439 / Virus Database: 271.1.1/2960 - Release Date: 06/25/10 06:35:00 Quote Link to comment Share on other sites More sharing options...
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