Subtle Presentation Of A Significant Neck Injury - Page #1

Author: Jamie Nuwer, MD
Co Author #1: Michael Henehan DO
Editor: Christopher Lutrzykowski, MD

Patient Presentation:
43 year-old male reports, "I was hit by a tree while dirt biking yesterday."

The patient was riding by himself and entered a ditch. When he came out the other side he didn't quite clear a fallen tree. He hit the top of his helmet on the underside of the tree and was knocked off his bike. He remembers feeling a shock down his spine as he was knocked off. Afterward, he felt like he "almost passed out" but denies full loss of consciousness. He was able to ride back to his car. The next day he came into clinic complaining of a headache and a neck ache. His only other complaint on review of systems was bilateral arm tingling and "feeling like his neck was a different shape."

Physical Exam:
Neck: no deformity, bruise at base of C-spine. Tender to palpation along all of C-Spine extending to mid-thoracic spine.
Spurling's test: did not make arm tingling worse. Distraction did not make tingling better.
Neurologic: CN II-XII grossly intact. UE strength, sensation, reflexes intact and symmetric. Rhomberg test: negative.

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