Question

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?

Answer 1

Ans a) Stiff neck is majorly caused due to injury which affects the muscles and the vertebrae. The muscle strain or soft tissue sprain causes the stiff neck and one of the most common muscle that is responsible for causing the stiff neck is levator scapulae. The muscle is susceptible to injury that connects the cervical spine of the neck to the shoulder. Due to its location in the back, the stiffness in the neck also causes back and shoulder pain.

Ans b) Brachium is the part of the arm which extends from the shoulder to the elbow. The triceps brachi muscles are the reason that causes the stiffness of the neck and the upper arm along with sending a tingling sensing.

Ans c) there are couple of mucles which are located in the archebrachium and each of it has its own function. If there is problem with the extensor carpi radialis muscle, it might lead to stiffness in the neck and shoulder as it lies against the radius and extends to the carpus. Another muscle which is responsible for causing the stiffness is the flexor carpi ulnaris muscle which is basically found deep into the head of the muscle and problem in such muscle leads to stiffness.

Ans 4) there are couple of skeletal bones which might impact the neck due to injury or fracture. Neck fractures are caused due to break in the cervical bone located in the neck and it might be due to sudden impact. There are 7 cervical vertebrae bones that are present on the neck which supports the skulls and head. The fracture and injury to them can be caused by sudden shock.