neuro symptoms from car accident

I am wondering if anyone can help me with this one....

I have a pt who had a car accident in Jan 2006. Her car was travelling at 30-35mph when it was hit from the side by a car who was also driving at approx 30-35mph.
She experienced immediate pain in her right hand, neck and shoulders. These increased over the next 24hrs. Attended A and E and x-rays were performed but were deemed normal and she was discharged.
Since then her pain has not changed, if anything it has got worse. She coomplains of a weakness/numbness in her right hand (all over), with a burning sensation in her neck and shoulders (upper traps), she also complains of a dull ache over C2-C6 approx. The pain in her neck and shoulder are constant, however the hand pain is intermittent.
It is causing her difficulty in sleeping, sitting for longer than 10mins aggrevates neck and shoulder pain and she is struggling to care for/lift and play with her two children (2 and 5yrs). The only things that tend to reduce the pain are hot baths and painkillers.
She works as a learning difficulties support worker but only works one night per week...nightshift in which she does not have to perform any manual handling.
She has reduced ROM in all movemnts of the Cx...flexion and extension being the worse causing radiation into the right arm and hand.
Any sort of palpation of the upper traps or surrounding muscles increases the burning sensation over the area and causes pins and needles into her hand.

Have tried both trigger point, massage, US and postural advice however very little effect.
She has had a couple of pain free days in between sessions but still complains of the burning sensation and weakness in hand nearly every session. I am totally confused and need help!I dont like bein a graduate physio!!

Any advice would be greatly appreciated!

thanks!

Your patient seems to suffer from the trauma to the cervical spine some kind of whiplash injury of the neck although not the classical whiplash which are usually rear end collisions or strikes. If the X-rays are clear, that means there is no evidence of fractures on any vertebrae of the cervical spine. But there seems to be a fair traumatic injury of the cervical soft tissues which may include the cervical intervertebal discs, ligaments, muscles and possible compression of the spinal cord or nerve roots. Treatment can be made more empirical if you make a detaled neurological examination of both upper limbs and lower limbs which should include sensory, motor, reflex testing, also looking for upper motor neuron signs. Your examination may provide the reason for apprent weakness in hand and the burning type of sensation experienced by the patient. That is most probably due to a neurological deficit due to a root compression or cord compression due to prolapsed disc or some soft tissue encroaching on neural structures. Just feedback us upon e results of your examination so that we may paln an effective management paln for that.

I agree with sdkashif.

The speed of the accident is fairly high for both parties. It has been roughly a year since the accident (or was that a typo?).

I have attached a file which contains the Australian NSW Motor Accidents Authority's Whiplash Guidelines. These include the classification of Whiplash Associated Disorders and the clinical pathways recommended. It can also be found at http://www.maa.nsw.gov.au/default.aspx?MenuID=141#127. It may be of help to you and justifies it position based on the evidence available as at 2003 i think.

Now, If it has been a year since the accident, then she is a chronic pain patient. She will be probably deconditioned and need deep neck flexor exercises, motor control retraining and rehabilitation with functional exercises. A good resource would be Diane Lee's book "The Thorax" available from her website dianelee.ca. It contains good functional rehab stuff for the thorax and UL.

Now, if it has only been 6 weeks, i would say that what she is feeling is pretty common. The jerking forces and impaction on one side of the spinal column and stretching of the other side is pretty great at 35mph. If she turned her head to look at the car coming at her, it would be even worse because on one side, the joints would be in closed packa nd the other side would be stretched open.

Good luck. Let us know more please

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