Whiplash/cervical instability

[Guest guest]

Hi colleagues- I have a 26 y/o healthy female who was in a MVC in California in early December.  Rear passenger position, seat belt on, no other vehicles involved.  Car hydroplaned at freeway speed, spun at least 2 times and slammed trunk first into the median barricade.  5 days later, she had mild to moderate cervical strain/sprain symptoms and visited a walk-in clinic, was offered a cervical collar and a Rx for Valium (as a muscle relaxer) and told she didn't need any follow-up.  Sx went away within a week.

 

Last week, roughly six weeks post MVC, she's leaning on an open window sill (for cell reception) and gets a sharp severe unrelenting pain at her left T-3-6 costovertebral region, made worse with head rotation (esp. right) and any sudden movement.  She went to the walk-in clinic here and may or may not have been seen by an MD (if she was seen, it was a fly-by), was sent for T-spine and C-spine xrays, minus cervical flex.extend films.  She made it into an acupuncture session on Saturday, and by yesterday afternoon, when she visited my office, was doing much better.  I reviewed her films and noticed possible rib subluxation/laxity, but what really caught my eye was a cervical kyphosis (no signs of degeneration) and C2 is 2.4 mm anterior to C3 ('s line).  I sent her for flex/extend films yesterday, and got a call from the radiologist that it's stable- " it's not moving " - phew!  Today, I get the flex/extend films and I am measuring C2 posterior 1.1mm on extension, 2.4mm anterior in neutral and 3.3mm anterior with flexion.  She doesn't have subjective pain in her neck (some tenderness upon palpation), and reports no neuro/weakness sx.  I had to stop the initial exam due to timing and will do further neuro testing on her next visit.

 

So- what measurement constitutes instability?  Is this a neuro consult?  MRI?  She claims to have a $5K PIP and I don't want to unnecessarily send her out for expensive diagnostics and end up with no money to get her well!

 

Thank you in advance for your advice.  Any literature references especially appreciated.

 

Dr. Ian Jarman D.C.Family Wellness ChiropractorCafe of Life @ Florence, Oregon(541)997-5100www.cafeoflife.com " Live as if your life depends on it " -Werner Erhard

[Guest guest]

Add the measurements up. It's either 3.5 mm or 4.5 for 25% whole body impairment. Check the AMA guide lines

    

Spinal quest Health Technologies

A Center for non-surgical treatment of Scoliosis

Carl  Bonofiglio, D.C.

503-608-7484

Cell 503-312-5744

www.spinalquest.net

-- Whiplash/cervical instability

Hi colleagues- I have a 26 y/o healthy female who was in a MVC in California in early December. Rear passenger position, seat belt on, no other vehicles involved. Car hydroplaned at freeway speed, spun at least 2 times and slammed trunk first into the median barricade. 5 days later, she had mild to moderate cervical strain/sprain symptoms and visited a walk-in clinic, was offered a cervical collar and a Rx for Valium (as a muscle relaxer) and told she didn't need any follow-up. Sx went away within a week.

Last week, roughly six weeks post MVC, she's leaning on an open window sill (for cell reception) and gets a sharp severe unrelenting pain at her left T-3-6 costovertebral region, made worse with head rotation (esp. right) and any sudden movement. She went to the walk-in clinic here and may or may not have been seen by an MD (if she was seen, it was a fly-by), was sent for T-spine and C-spine xrays, minus cervical flex.extend films. She made it into an acupuncture session on Saturday, and by yesterday afternoon, when she visited my office, was doing much better. I reviewed her films and noticed possible rib subluxation/laxity, but what really caught my eye was a cervical kyphosis (no signs of degeneration) and C2 is 2.4 mm anterior to C3 ('s line). I sent her for flex/extend films yesterday, and got a call from the radiologist that it's stable- "it's not moving"- phew! Today, I get the flex/extend films and I am measuring C2 posterior 1.1mm on extension, 2.4mm anterior in neutral and 3.3mm anterior with flexion. She doesn't have subjective pain in her neck (some tenderness upon palpation), and reports no neuro/weakness sx. I had to stop the initial exam due to timing and will do further neuro testing on her next visit.

So- what measurement constitutes instability? Is this a neuro consult? MRI? She claims to have a $5K PIP and I don't want to unnecessarily send her out for expensive diagnostics and end up with no money to get her well!

Thank you in advance for your advice. Any literature references especially appreciated.

Dr. Ian Jarman D.C.Family Wellness ChiropractorCafe of Life @ Florence, Oregon(541)997-5100www.cafeoflife.com"Live as if your life depends on it"-Werner Erhard

[Guest guest]

Any one in your area doing Pettibon or CBP?

    

Spinal quest Health Technologies

A Center for non-surgical treatment of Scoliosis

Carl  Bonofiglio, D.C.

503-608-7484

Cell 503-312-5744

www.spinalquest.net

-- Whiplash/cervical instability

Hi colleagues- I have a 26 y/o healthy female who was in a MVC in California in early December. Rear passenger position, seat belt on, no other vehicles involved. Car hydroplaned at freeway speed, spun at least 2 times and slammed trunk first into the median barricade. 5 days later, she had mild to moderate cervical strain/sprain symptoms and visited a walk-in clinic, was offered a cervical collar and a Rx for Valium (as a muscle relaxer) and told she didn't need any follow-up. Sx went away within a week.

Last week, roughly six weeks post MVC, she's leaning on an open window sill (for cell reception) and gets a sharp severe unrelenting pain at her left T-3-6 costovertebral region, made worse with head rotation (esp. right) and any sudden movement. She went to the walk-in clinic here and may or may not have been seen by an MD (if she was seen, it was a fly-by), was sent for T-spine and C-spine xrays, minus cervical flex.extend films. She made it into an acupuncture session on Saturday, and by yesterday afternoon, when she visited my office, was doing much better. I reviewed her films and noticed possible rib subluxation/laxity, but what really caught my eye was a cervical kyphosis (no signs of degeneration) and C2 is 2.4 mm anterior to C3 ('s line). I sent her for flex/extend films yesterday, and got a call from the radiologist that it's stable- "it's not moving"- phew! Today, I get the flex/extend films and I am measuring C2 posterior 1.1mm on extension, 2.4mm anterior in neutral and 3.3mm anterior with flexion. She doesn't have subjective pain in her neck (some tenderness upon palpation), and reports no neuro/weakness sx. I had to stop the initial exam due to timing and will do further neuro testing on her next visit.

So- what measurement constitutes instability? Is this a neuro consult? MRI? She claims to have a $5K PIP and I don't want to unnecessarily send her out for expensive diagnostics and end up with no money to get her well!

Thank you in advance for your advice. Any literature references especially appreciated.

Dr. Ian Jarman D.C.Family Wellness ChiropractorCafe of Life @ Florence, Oregon(541)997-5100www.cafeoflife.com"Live as if your life depends on it"-Werner Erhard

[Guest guest]

Hi Ian,The radiologist has already indicated that the motion segment is stable true instability is a surgical condition 3.3 of anterior translation is getting close to loss of motion segment integrity which is not the same as frank instability but constitutes a grade/class II ligament injury. Since she has a kyphotic neck curve I’d look for a increase in intraspinous process distances also indicating intraspinous ligament injury…….Vern SAboe From: [mailto: ] On Behalf Of Ian JarmanSent: Tuesday, January 18, 2011 3:30 PM ; Dr. Lana Surgenor; david boorsteinSubject: Whiplash/cervical instability Hi colleagues- I have a 26 y/o healthy female who was in a MVC in California in early December. Rear passenger position, seat belt on, no other vehicles involved. Car hydroplaned at freeway speed, spun at least 2 times and slammed trunk first into the median barricade. 5 days later, she had mild to moderate cervical strain/sprain symptoms and visited a walk-in clinic, was offered a cervical collar and a Rx for Valium (as a muscle relaxer) and told she didn't need any follow-up. Sx went away within a week. Last week, roughly six weeks post MVC, she's leaning on an open window sill (for cell reception) and gets a sharp severe unrelenting pain at her left T-3-6 costovertebral region, made worse with head rotation (esp. right) and any sudden movement. She went to the walk-in clinic here and may or may not have been seen by an MD (if she was seen, it was a fly-by), was sent for T-spine and C-spine xrays, minus cervical flex.extend films. She made it into an acupuncture session on Saturday, and by yesterday afternoon, when she visited my office, was doing much better. I reviewed her films and noticed possible rib subluxation/laxity, but what really caught my eye was a cervical kyphosis (no signs of degeneration) and C2 is 2.4 mm anterior to C3 ('s line). I sent her for flex/extend films yesterday, and got a call from the radiologist that it's stable- " it's not moving " - phew! Today, I get the flex/extend films and I am measuring C2 posterior 1.1mm on extension, 2.4mm anterior in neutral and 3.3mm anterior with flexion. She doesn't have subjective pain in her neck (some tenderness upon palpation), and reports no neuro/weakness sx. I had to stop the initial exam due to timing and will do further neuro testing on her next visit. So- what measurement constitutes instability? Is this a neuro consult? MRI? She claims to have a $5K PIP and I don't want to unnecessarily send her out for expensive diagnostics and end up with no money to get her well! Thank you in advance for your advice. Any literature references especially appreciated. Dr. Ian Jarman D.C.Family Wellness ChiropractorCafe of Life @ Florence, Oregon(541)997-5100www.cafeoflife.com " Live as if your life depends on it " -Werner ErhardNo virus found in this incoming message.Checked by AVG - www.avg.comVersion: 8.5.449 / Virus Database: 271.1.1/3388 - Release Date: 01/18/11 07:34:00