CERVICOTHORACIC MVA: TIPS AND PROGRESSIONS FOR BEST OUTCOMES KAREN WALZ, PT, DPT, OCS, COMT, FAAOMPT FREEIMAGES.COM
ACUTE MVA KINEMATICS Rear End Collision Mechanics Stage 1- Retraction; "S" Curve Stage 2- Hyperextension Stage 3- Hyperflexion Yoganandan 2013; www.tinnutusformula.com
CASE #1 55 YR OLD MALE, 3 WEEKS POST REAR- END MVA. NECK PAIN 3/10 WITH SUBOCCIPITAL HEADACHE AND CERVICOTHORACIC ACHE. SYMPTOMS AGGRAVATED BY SUSTAINED NECK POSTURES, COMPUTER WORK, DRIVING. SLEEP OK. EASED SOMEWHAT WITH LYING DOWN, ICING. NUMBNESS/TINGLING RT DOMINANT ARM RT 1-2ND FINGERS AND OCCASIONALLY LT THUMB IS PATIENT APPROPRIATE FOR PT? PAIN 'STORY'? DIFFERENTIAL DIAGNOSIS? KEY TESTS? TREATMENT FOCUS? WWW.IFOMPT.COM; Fortin et al, 2017
PAIN 'STORY'- WHAT DRIVES THEIR PAIN SYMPTOMS? Biomechanical, MSK- tissue, system Socioeconomicmotivational, litigation Psychological - coping,stress reactions
PAIN DRIVER EARLY INFLUENCE ON OUTCOMES 45% show 'rapid recovery' 39% trend toward 'moderate recovery' 16% trended toward 'poor recovery' and chronic symptoms over 12 months, at 1 month post assessments Sterling et al. 2010; http://www.physio-pedia.com/neck_disability_index HYPERSENSITIVITY PTSD COLD HYPERALGESIA https://naiomt.me/?s=mva (cold hyperalgesia test method) PTSD self test https://www.adaa.org/screeningposttraumatic-stress-disorderptsd Rivest et al 2010 ; Ritchie 2013
EMERGING CLINICAL PREDICTION RULE- MVA OUTCOMES >/ 40% NDI >/35 yr old PDS >/ PTSD sc POOR POST-MVA CLINICAL OUTCOMES Ritchie 2013; Rivest et al 2010; PCS
CASE #2 39 yr old male, retail IT troubleshooter, involved in rear-end MVA 3 months ago. He complains of mild Lt neck pain 2/10, fatigue, feeling "foggy" (especially with looking up), difficulty concentrating and with some long term memory skills. Imaging negative, gross neuro screen WNL. Mild Lt cerv rotation AROM loss. Past 4 chiro treatments helped neck pain somewhat IS PATIENT APPROPRIATE FOR PT? PAIN 'STORY'? DIFFERENTIAL DIAGNOSIS? KEY TESTS? TREATMENT FOCUS? Mucha, et al 2014
DIFFERENTIAL DIAGNOSIS Vestibulo- Oculomotor Dix-Hallpike BPPV VOMS Where to Start? Concussion SCAT 3 Postconcussion Symptom Scale Sensorimotor Joint position sense Neck movement control
CASE #3 23 yr old female, involved in side impact collision 2 months ago in commercial parking lot (estimated speed 8 mph). Neck pain 7/10, head feels "heavy" at times (end of work day, lifting head from lying in bed) as receptionist at busy legal office. She worries a lot about her neck "never getting better" IS PATIENT APPROPRIATE FOR PT? PAIN 'STORY'? DIFFERENTIAL DIAGNOSIS? KEY TESTS? TREATMENT FOCUS? Initial imaging & neuro screen negative. PCP prescribed muscle relaxer and OTC pain meds; she feels these helped initially
TREATMENT Deep neck flexor activation (CCFT) O'Leary S, Jull G, et al. 2007
TREATMENT Deep neck extensor activation Schomacher 2015
TREATMENT Somatosensory Kristjannson E et al. 2009
Consider the patient's "pain story" SUMMARY KAREN WALZ, PT, DPT Walz@naiomt.com Use appropriate screening tools and predictive analytics to help you gauge outcomes and progress of patient Classify and prioritize any multiregional or multi-system diagnoses to progress your plan of care Treat acute neuro/vestibulo-ocular symptoms and MSK to allow full progression to functional activity Give the patient tools 'for success' in long term management
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