PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1
A 29-year-old man presents with acute neck pain after trauma to the cervical spine during soccer practice. He was immobilized with a rigid cervical collar for 6 weeks after advanced imaging confirmed a pars defect at the C4 level. Currently, he presents with guarded movement in all directions and increased tone and tenderness in the cervical spine musculature. Significant weakness is noted in the longus colli, longus capitis, middle trapezius, and rhomboids. Neurological examination is negative, and the patient’s goal is to return to playing soccer.
SIGNS AND SYMPTOMS
Pain in the cervical spine, shoulder, arm, upper extremity
Stiffness along the spine
Pain in the cervical spine worsens with extension
Schematic drawings of spondylolysis (A), and spondylolisthesis (B). (From Patel DR, Greydanus DE, Baker RJ. Pediatric Practice: Sports Medicine. www.accesspediatrics.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Difficulty sustaining standing postures secondary to neck and arm pain
Inability to sleep flat on the back without a pillow
Difficulty with movements (reaching overhead) secondary to pain
Limit sports participation
Possible Contributing Causes
Forceful extension from hit under the chin (sports)
Car accident, hit from rear
Hyperextension of the cervical spine
Increased cervical lordosis posture
MEANS OF CONFIRMATION OR DIAGNOSIS
MRI helps to visualize compressed or inflamed nerve root in diagnosis2
X-ray/Plain-film radiograph to see vertebra position3
CT scan to show herniation compressing the spinal canal/nerves3
Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function4
FINDINGS AND INTERPRETATION
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