Presentation on theme: "CERVICAL HYPOLORDOSIS: A CASE STUDY OF TREATMENTS AND OUTCOMES E MILY Z IPOY, M ATHEW K ALAPURAYIL, R HONDA C ROSS B EEMER P H D, ATC (M ENTOR ) Drake."— Presentation transcript:
CERVICAL HYPOLORDOSIS: A CASE STUDY OF TREATMENTS AND OUTCOMES E MILY Z IPOY, M ATHEW K ALAPURAYIL, R HONDA C ROSS B EEMER P H D, ATC (M ENTOR ) Drake University College of Pharmacy and Health Sciences RESULTS OF DIAGNOSTIC IMAGING MRI and radiograph Revealed a chronic history of reverse cervical spine curvature and osteophytes along posterior and lateral vertebral bodies C5/C6. REFRENCES 1. Olson, V. L. (1007). Whiplash- Associated Chronic Headache Treated with Home Cervical Traction. Physical Therapy, 417-424. 2. Schenkman, M. (1996). relationships between mobility of axial structures and physical performance. Physical Therapy, 3. 3. http://www.coralvillechiropractic.us/photo.htm 4. http://www.med.nyu.edu/hjd/hjdspine/education/problems/neckandarm/cervicalspond.html 5.McKinley, Michael P., and Valerie Dean. O'Loughlin. Human Anatomy. Boston: McGraw-Hill Higher Education, 2008. Print. 6. http://occaraccident.wordpress.com/2009/10/02/do-you-know-the-most-important-physical-sign-to-look-for-after-a-car-accident-in-orange-county-ca/ * : Images used in this poster are not from this particular case study and do not represent the studied patient. Images are being used to supplement the presented information and provide visual representation of the different aspects of this particular case study. ABSTRACT BACKGROUND: Cervical hypolordosis is a condition affecting the cervical vertebrae in which the normal anterior curvature shifts posteriorly from its original position, creating a flattening, causing pain and neuropathy in patients. Little data exists on the causes, treatment, and progression of this condition which gives motive for this case study. CASE PRESENTATION: A moderately active 51 year old female patient sought chiropractic treatment after experiencing numbness in the 3 rd, 4 th, and 5 th digits of the left hand. She was diagnosed with a strain within the supraclavicular region. A hypolordotic curve of the cervical vertebrae was noted upon visual examination. Treatment using chiropractic techniques led to 90% pre-injury strength. The patient later returned with further neuropathy signs and symptoms. A differential diagnosis included thoracic outlet syndrome or disk herniation of the cervical vertebrae. An MRI revealed reverse cervical curvature and osteophytes along the lateral bodies of C5/C6 vertebrae. TREATMENT: A treatment plan and protocol was followed addressing biomechanical changes utilizing chiropractic adjustments, proprioceptive neuromuscular facilitation, stretching exercises, and a home exercise program. CONCLUSION: Within only four treatments over a 2-week rehabilitation program, using therapeutic exercises and chiropractic adjustments, a 90% self improvement of symptoms was reported by the patient. With so little evidence about cervical hypolordosis, it is important to note the positive outcomes of this patient and to utilize the information to treat and/or educate others who suffer from cervical hypolordosis. PERSONAL DATA/PERTINENT MEDICAL HISTORY 51 year old moderately active female presented with 3 rd, 4 th, and 5 th digit numbness after performing a pectorals deck exercise (June 2010) Initial examination revealed: Hyperactive deep tendon reflex in the left bracioradialis Pain in the left elbow and hyperesthesia of C6 and C7 dermatomes Mild left arm supination and pronation weakness Elbow flexion with resistive range of motion. Patient would later return in November 2010 with exacerbating symptoms PHYSICAL SIGNS AND SYMPTOMS First visit Positive bilateral Cervical Jackson’s compressions test Pain in left subclavicular region Hypertonicity within the right supraclavicular and cervicothoracic region. Complaints were reproduced with left elbow lateral to medial compression Diagnosed with a strain or sprain within the supraclavicular region that manifested as radiating numbness Second Visit Shooting pain in right tricep and lateral forearm Return of digit numbness (3 rd, 4 th, 5 th ) Unknown mechanism of injury Pain was a gradual onset Normal deep tendon reflex responses Point tenderness within the right C4-C6 spinal region with active trigger points in supraspinatous and supraclavicular regions Increase in symptoms with passive and active range of motion of cervical lateral flexion DIFFERENTIAL DIAGNOSIS First visit Cervical hypolordosis Carpal tunnel syndrome Supraclavicular strain Second Visit Thoracic outlet syndrome Disk herination. CLINICAL PLAN & PROTOCOLS The below plan was performed over a 2 week period with the hope of the patient continuing the home exercise program. Chiropractic adjustment Combination ultrasound and electrical muscle stimulation Ice massage Wrist brace to wear Proprioceptive neuromuscular facilitation Active isolated stretching Myofascial release Home exercise program Isometric contract/relax cervical extension exercises, static extension, bilateral lateral flexion and bilateral rotation stretches. BACKGROUND Cervical hypolordosis, commonly referred to as "flat neck" or "straight neck," is a term used to define loss of curvature in the cervical spine. Usually the neck has a lordotic curvature, which is minimally present or even absent in hypolordosis. There are varying theories and speculations as to why this abnormality occurs. Previous studies have attributed it to abnormal development of the spine during embryogenesis, trauma from motor vehicle collisions(MVCs) or a sporting accident, 1 as well as chronic back pain and neurologic disorders. Over time these events can lead to poor postural alignment 2 ; the most common cause for cervical hypolordosis 2. The purpose of this retrospective case report is to review treatments and outcomes of a patient diagnosed with cervical hypolordosis due to limited research pertaining to cervical hypolordosis. This poses a significant problem for clinicians in treating the disorder. CONCLUSION Diagnosed with cervical hypolordosis with osteophytes Supraclavicular strain impingement of nerves pain and numbness. Patient experienced dermatome numbness and hyperexcitable deep tendon reflexes Assessment techniques used to narrow diagnosis possibilities. Treatments focused on managing cervical hypolordosis and supraclavicular strain Patient rapidly improved and was released from care after few treatments Not reassessed for change in cervical angle before being discharged. Patient left with knowledge and ability to perform home exercise program. *Figure 1: Cervical Hypolordosis 3 *Figure 3: Osteophytes along cervical spine 4 *Figure 5a: Radiograph of cervical spine from initial visit indicating cervical hypolordosis (Before treatment ) 6 *Figure 4: Dermatome Map 5 *Figure 5b: Radiograph of cervical spine curvature after treatment therapies 6 *Figure 2: Cervical Jackson Compression Test
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