Neck Injury-Motor Vehicle Accident

Abstract

HISTORY: A 57-year-old male was involved in a motorcycle accident, landing on his right side. Injuries included a flaccid right arm and hand, laceration of his right thigh, and a fracture of the 3rd metatarsal of his right foot. Patient’s chief complaint was pain in right shoulder and neck and an inability to complete ADLs. PHYSICAL EXAMINATION: Patient demonstrated flaccid right upper extremity with very little finger movement. Patient was able to achieve some finger flexion of all 5 digits and thumb opposition to index finger, although could not achieve pad to pad contact. All PROM of joints was preserved. Sensation was grossly intact. Patient tolerated initial examination well with mild discomfort during objective measures. No red flags arose during medical screening/systems review. DIFFERENTIAL DIAGNOSIS: 1. Cerebrovascular accident 2. Brachial plexus stretch injury 3. Brachial plexus avulsion injury TESTS AND RESULTS: MRI of cervical spine without contrast – small disc herniation, MRI of brachial plexus with and without contrast - edema involving right scalene and adjacent fascial planes extending into brachial plexus as well as into right C6/C7 and C7/T1 neural foramen to confirm nerve root sleeve tears, CTA of neck – negative for artery involvement, EMG study showed that the brachial plexus was not avulsed, but not currently sending EMG signals to hand. FINAL/WORKING DIAGNOSIS: Brachial plexus stretch injury TREATMENT AND OUTCOMES: 1. Therapeutic exercises (ROM, strength, endurance, stability), 2. Therapeutic activity (work specific, ADL specific), 3. Neuromuscular rehabilitation (muscle re-education, sequencing, coordination, neurodynamics), 4. Patient education (home exercise program, home safety). Patient has been responding well to a treatment plan combining aspects of the above mentioned interventions. Has been showing greater activation of right hand and forearm muscles with ability to complete weak grip at this stage. Right upper extremity remains supported in sling.