A 24yearold female visits her GP after having been in an aut

A 24-year-old female visits her GP after having been in an automobile accident three days prior. She reports that while driving in slippery conditions she rear-ended the car in front of her and she was then rear-ended by the car behind her. She was traveling at about 30 mph and her airbags did employ. She reports first responders found no injuries but advised her to follow up with her GP if she developed any unusual symptoms. The woman reports that she seemed fine after the accident but did wake the morning after with a bit of a stiff neck and a headache; she didn\'t feel this was unusual given the accident and went on about her day. At the end of the next day she had to carry heavy bags up two flights of stairs to her apartment and when almost to her door she felt a zing all the way down her right arm. She immediately put the bags down. When she lifted the bags again her right arm felt numb. She woke this morning with a very stiff neck, stiffness in her upper arm, and “tingles” in her neck and down her entire arm. Musculoskeletal examination revealed limited ability to flex the neck – guarding by the posterior muscles of the neck, reduced ability to extend and flex the elbow, reduced ability to extend the wrist and digit, and general peripheral neuropathy (loss of muscle innervation and cutaneous sensation) to the arm. From your knowledge to date from discussions in the class, and use of critical reasoning, please answer the following questions.

1. What muscles of the neck have been affected?

2. What muscles of the brachium have been affected?

3. What muscles of the antebrachium have been affected?

4. If the woman was in a state of shock she might not have realized a skeletal injury; what skeletal elements (bones) and features would be associated with the effected muscles of the neck? In other words, what specific bones/bone features may have been injured?

5. If the woman was in a state of shock she might not have realized a skeletal injury; what skeletal elements (bones) and features would be associated with the effected muscles of the brachium?

6. If the woman was in a state of shock she might not have realized a skeletal injury; what skeletal elements (bones) and features would be associated with the effected muscles of the antebrachium?

7. Given the woman has peripheral neuropathy (loss of innervation to muscle tissue and cutaneous sensation) of the neck and arm what axial skeletal region has likely been affected?

8. What specific feature of the axial skeletal element would have caused compression of spinal nerves?

9. From the above information (case study and answering the questions) what condition do you believe the woman has as a result of her accident?

10. What diagnostics, if any, would you employ to further investigate the injury – and why or why not?

Solution

Please find the answers below:

Part 1: From the description given by the patient, it seems that the muscles of back of the neck and shoulder particularly on right side have been affected. From the observation that the patient has numbness on right hand, the levator scapulae and multifdus muscles might have been affected. Since the patient also feels dizziness, her cervical might also have been affected.

Part 2: The description of the patient suggests that stiffness in arm and numbness have arised. This might be due to damage to muscles of upper and lower arm/brachium. Since the patient also has difficulty in pulling weight, it seems that her deltoid process might have been affected. This also correlates to the problem of stiffness in neck. Also, the biceps brachii might also have been affected and contributing to this problem.

Part 3: Since the patient feels numbness in hands and problem in pulling weight, the muscles and nerves of antebrachium or forearm were also affected. From the description, it is suggested that the grip of patient is also poor post-accident. Thus, the abductor and extensor muscles of antebrachium must be affected.

Part 4: Although the patient has no relavant sign of bone-injury, but the feeling of dizziness and nausea gives an indication that her cervical bone might have been affected. This also directly correlates with the problem in shoulder, forearm and stiffness of the neck and arm.