welcome to week 3 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Welcome to week 3 PowerPoint Presentation
Download Presentation
Welcome to week 3

Loading in 2 Seconds...

play fullscreen
1 / 37

Welcome to week 3 - PowerPoint PPT Presentation


  • 59 Views
  • Uploaded on

Welcome to week 3. Last week we looked a Thoracic outlet case. Group assignment. Yura Weiner. Neck pain with severe left arm pain Take a history. History.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Welcome to week 3' - willem


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
welcome to week 3
Welcome to week 3

Last week we looked a Thoracic outlet case

yura weiner
Yura Weiner

Neck pain with severe left arm pain

Take a history

history
History
  • 45 year-old right-hand dominant man shipping manager presents with a 2-month history of severe left arm pain and weakness to the degree that he cannot work
  • Lower left neck pain 9/10 NPS
  • Left trap pain 9/10 NPS
  • Feels best with left arm raised with the forearm resting on his head
  • No real HA complaint
  • Some numbness and tingling in his left index and middle fingers – both sides
  • Some weakness when he lifts something that requires him to flex his wrist. He feels that although his grip seems strong, it is not as strong as it used to be.
  • Pain medications have offered little relief
  • He saw his MD who ordered Injections in his neck, which\ were also of little help
how might you explain
How might you explain
  • The pain complaints
  • The weakness
  • The numbness and tingling
  • The palliative behavior
answer for each ddx
Answer for Each DDx
  • What motor findings do you expect? Why?
  • What sensory findings to you expect?
  • What other findings should you look for?
  • What would your examination look like?
  • What would you tell your patient?
    • ROF
    • Chiropractic care
    • Treatment time frame etc
yura s examination
Yura’s Examination
  • He had significant weakness in his left triceps (+3/5) as well as his left wrist flexors (+3/5) and finger extensors (+4/5)
  • He had dense numbness involving his left index and middle fingers
imaging
Imaging
  • Plain film X-rays show mild DJD in the posterior joints and decreased IVD at C5-6 and C6-7
imaging1
Imaging
  • MRI shows a large disc herniation on the left at the C6-C7 level impinging on the spinal cord and nerve root.
differentials
Differentials
  • Disc / Stenosis
    • X-ray
    • MRI
  • Entrapments
    • Electrophysiological evaluation
      • Often normal in TOS, but positive in distal problems
case process
Case Process
  • Create a detailed outline of each differential
    • Definition
    • Etiology
    • Epidemiology
    • Signs & symptoms – including detail about relevant anatomy, physiology, dermatome, myotome
    • Exam findings
    • Special studies indicated
    • Course of the disorder
    • Treatment
    • Prognosis
muscle atrophy
Muscle atrophy
  • Which muscles are affected?
  • What is their nerve root innervation?
stages of disc herniation
Stages of Disc Herniation
  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP)
slide17
C7

C5

Ext Dig. Comm C7

Ext Indicus proprius C7

Ext Dig. Minimi C7

Triceps DTR

C6

C7

Radial N

C5-T1

Flex. Carp. Rad C7

Flex. Dig. Sup C7

Flex. Dig. Prof ½ C7

Median N

C5-T1

C8

Ulnar N

C5-T1

Flex. Carp. Ulnaris C7

T1

disc related signs symptoms
Disc-related Signs & Symptoms
  • C4 - C5 (C5 nerve root) –
    • Can cause weakness in the deltoid muscle and shoulder pain
    • Does not usually cause numbness or tingling
  • C5 - C6 (C6 nerve root) –
    • Can cause weakness in the biceps and wrist extensor muscles
    • Numbness and tingling along with pain can radiate to the thumb side of the hand
disc related signs symptoms1
Disc-related Signs & Symptoms
  • C6 - C7 (C7 nerve root) –
    • Can cause weakness in the triceps and the finger extensor muscles
    • Numbness and tingling along with pain can radiate down the triceps and into the middle finger
  • C7 - T1 (C8 nerve root) –
    • Can cause weakness with handgrip
    • Numbness and tingling and pain can radiate down the arm to the medial hand
diagnosis
Diagnosis
  • Disc herniation C6-C7 affecting function of the nerve
treatment
Treatment
  • Opted for surgery
  • C6-C7 anterior cervical discectomy and fusion (ACDF) involving removal of the disc from the front of the neck, replacement with bone graft, and placement of a plate for stabilization of the level.
slide23
Bart
  • 38-year-old male complains of lower neck and shoulder region pain for the past four weeks
history1
History
  • Involved in an ATV accident on the beach in Mexico. He came up over a sand dune and lost control of the ATV causing it to veer left and his body to go to the right. He landed on the sand and immediately felt neck pain
  • He got back on the ATV and continued his day. The next day, he had neck and shoulder pain that he rated as 8/10 with movement and 6/10 at rest
  • He used ice for a day or two and took a few Advil each day for two day. No other care.
  • Never had anything like this before
  • Currently, the pain is 2/10 at rest and 6/10 with certain overhead arm movements
  • No paresthesia or weakness in his arm or hand although he does feel some weakness when lifting over head