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    Week 5 Portfolio Questions

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    This case study involves two patients presenting with headaches. The first, Joe, is a 35-year-old male with neck pain and headaches seeking a cervical adjustment. Examination finds hypermobility and hypertonicity in his cervical spine. The second, Alison, is a 70-year-old female with a history of headaches and recent interscapular pain. Examination of Alison finds limited cervical range of motion and tightness in her rhomboids and trapezius. The case study poses several questions about differential diagnoses, examination findings, and management plans for the two patients.

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    Week 5 Portfolio Questions

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    44 views4 pages
    This case study involves two patients presenting with headaches. The first, Joe, is a 35-year-old male with neck pain and headaches seeking a cervical adjustment. Examination finds hypermobility and hypertonicity in his cervical spine. The second, Alison, is a 70-year-old female with a history of headaches and recent interscapular pain. Examination of Alison finds limited cervical range of motion and tightness in her rhomboids and trapezius. The case study poses several questions about differential diagnoses, examination findings, and management plans for the two patients.

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    This case study involves two patients presenting with headaches. The first, Joe, is a 35-year-old male with neck pain and headaches seeking a cervical adjustment. Examination finds hypermobility and hypertonicity in his cervical spine. The second, Alison, is a 70-year-old female with a history of headaches and recent interscapular pain. Examination of Alison finds limited cervical range of motion and tightness in her rhomboids and trapezius. The case study poses several questions about differential diagnoses, examination findings, and management plans for the two patients.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    44 views4 pages

    Week 5 Portfolio Questions

    Uploaded by

    api-479716004
    This case study involves two patients presenting with headaches. The first, Joe, is a 35-year-old male with neck pain and headaches seeking a cervical adjustment. Examination finds hypermobility and hypertonicity in his cervical spine. The second, Alison, is a 70-year-old female with a history of headaches and recent interscapular pain. Examination of Alison finds limited cervical range of motion and tightness in her rhomboids and trapezius. The case study poses several questions about differential diagnoses, examination findings, and management plans for the two patients.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 4

    Week 5 CASE STUDY 5 CHIR13009

    CASE STUDY AND QUESTIONS: To be completed by the 16 th August


    Case 5 Joe is a 35-year-old male.

    Presenting Complaint:
    Neck pain and occasional headaches. The neck pain was intermittent and aching in
    nature. This began over the last 10-15 years. Since this time, he had adjustments
    every week at least twice a week by a chiropractor in Tasmania. Now in Sydney, he
    wants to have an adjustment which involves a position of rotation and then a strong
    twist into further rotation and traction. The patient was insistent that the adjustment
    be performed.
    Physical Examination
    Palpation: Hypermobility throughout the cervical spine. There was marked
    hypertonicity throughout the cervical spine and shoulders bilaterally. There was
    normal neurology, orthopaedic tests and physical examination findings.

    1) What is the likely diagnosis? Give reasons for your answer.

    Early spinal instability – caused by excessive and abnormal segmental motion,


    identified by a positive instability test without neurological symptoms. Deformity
    under load exceeds the capacity for the tissues under load.

    2) Does this sort of adjustment described have dangers? Please explain


    the mechanisms involved.

    Yes further instability can be induced by compression and torsion forces causing
    loss of nuclear integrity. So adjustments of the joint complex would not be advised

    Case 5b Alison 70-year-old female

    Presenting Complaint:
    Alison presents to you with recurrent headaches. She has suffered from various
    types of headaches since adolescence. She admits that stress appears to bring the
    headaches on, and that they are sometimes accompanied by feelings of dizziness
    and nausea.
    Previous investigations over the years never revealed any pathology, and she was
    regularly reassured by her medical practitioner that ‘they were nothing to worry
    about’.

    History of Presenting Complaint:


    She smoked 10 cigarettes per day from the age of 16 to 60 years of age but has not
    smoked since. She drinks occasionally but she says that it is not to excess.
    She also complains of recent a 2-month history of occasional pain between the
    scapulae, which seem to occur when she goes shopping, or after a large meal. The
    pain is mild and does not seem too troublesome.
    Week 5 CASE STUDY 5 CHIR13009

    She denies any other health problems or past trauma and has not had any
    operations. She did suffer a whiplash injury after a heavy rear end motor vehicle
    collision some 20 years ago which caused pain for a couple of months. She takes
    no medications apart from Nurofen (ibuprofen) and Nurofen Plus (ibuprofen plus
    codeine), which she uses to control here headaches.

    1. What other further pertinent questions would you ask Alison.


    Any trauma, location and intensity of HA, any triggers, questions around eating,what
    kinds of foods, any red flag questions, signs and symptoms of flu, medications
    ,drugs, eyeglasses.

    2. Using ONLY the information in the above case history, give 3 likely
    differential diagnoses for;
    a. Her headaches
    Tension type cervico genic headache induced by stress

    b. Her interscapular pain


    GERD or ulcer. Back pain after eating is likely caused by referred pain

    3. What do you need to examine?


    Vital signs: temp, throat, lymphatics, abdominal examination
    Cardiovascular exam

    Physical Examination.
    Alison is tall and slightly overweight and walks with slightly hunched shoulders.
    Vitals: Pulse rate/min = 62, Respiratory rate/min =10, Blood pressure/mm Hg =
    150/95,
    Height (cm) = 175, Weight (kg) = 85, BMI 27.7, Temperature (degrees) = 36.1

    Her neck ROM is limited to left rotation by about 35% with minimal pain. Cervical
    extension is uncomfortable at the extreme of range limited by 50%. Orthopaedic,
    UMN and LMN tests are negative.
    Interscapular region: tightness of rhomboids and trapezius.
    Abdomen: Soft, non-tender, no masses.
    4. Using ONLY the information above do you think Alison is suffering
    from:
     Cervicogenic headaches
     Classic migraine
     Cluster headaches
     Common Migraine
     Subdural hematoma
    (Not likely or more likely)

    5. What are possible causes of her interscapular pain? Why?


    Posture = slouching causing rounded shoulders brought on by possible
    osteoporosis. Bending forward to bring food to her mouth can also contribute to
    digestive problems (eating at test and couch causes hunching)
    Week 5 CASE STUDY 5 CHIR13009

    6. Do you think it was necessary to take vital signs? Are the vital signs
    normal/abnormal?
    Vitals: Pulse rate/min = 62, Respiratory rate/min =10, Blood pressure/mm Hg =
    150/95, hypertensive headache

    7. Do you think an abdominal exam is necessary or do you think this is


    ‘over examining the patient’?
    Yes it is necessary to investigate digestive conditions- could be an ulcer, gall stones
    or appendicis.

    8. If this patient was diagnosed with common migraines, what is your


    proposed treatment/plan of management?
    Correct postural imbalances, ergonomics, myofascial trigger points. Then exercises,
    stretches, physiotherapy or acupuncture

    9. How would you manage her interscapular pain?


    Investigate and treat accordingly with gentle chiropractic care, postural correction
    exercises. If unresolved pain then refer to GP for MRI and full blood tests to rule out
    malignancy due to history of smoking.

    General Questions

    1. Give the 2 categories for headaches and give examples for each.
    Primary headaches = migraines and TTH
    Secondary = caused by trauma or injury to head and neck or caused by cranial or
    cervical vascular disorder
    2. List the ‘red flags’ for headaches.
    Recent onset, Position of headache, focal neurological signs, progressive nature,
    cognitive changes, raised temp/fever
    3. Give a list of the differential diagnoses of non-primary causes of
    headaches.
    Caused by trauma/injury, cranial/cervical vascular disorder, nonvascular disorders,
    disorders of ears/neck/nose/cranium etc., caused by infection, psychiatric
    4. Differential between tension headaches and classic migraine
    headaches.
    Classic Migraine
    headaches preceded by temporary focal neurological deficits (Prodrome)
    headaches accompanied by nausea, vomiting ± photophobia
    headaches triggered by certain foods or alcohol (red wine, chocolate, oranges,
    cheeses)
    headaches made worse by bright light or noises
    Tension Type Headaches
    headache relieved by massage
    headache described as a tight band
    Week 5 CASE STUDY 5 CHIR13009

    5. Give a list of triggers that could lead to classic migraines?


    Wine, cheese, alcohol, bright lights, noise levels, smoking, cured meats, chocolate,
    oranges
    6. How would you manage a patient with classic migraine headaches?
    Reduce triggers, modify patient behavior, chiropractic management,
    Quiet darkened room, adjunctive therapy eg massage, accupuncture,
    Nutritional support advice
    7. Describe the clinical presentation for cervicogenic headaches?
    • Intersegmental hypomobility (primarily in the upper cervical area)
    • Specific tender points
    • Dysfunctional motion of the cervical spine
    • Postural imbalance (forward head position and round-shoulder appearance)
    8. Describe the clinical presentation for cluster headaches?
    Pain around the eye with tearing
    Often wakes with a headache at night
    Can occur a number of times per day in clusters of 1- 2 hours
    9. Describe the clinical presentation of hypertension headaches?
    Headache associated with a diastolic blood pressure greater than 115 mm Hg
    (possible hypertensive headache)
    Pulsatile in nature
    10. Describe the clinical presentation for temporal arteritis?
    A new headache in the elderly
    Painful torturous temporal arties on palpation
    Deep throbbing in their temples and upper trunk 9neck and shoulder area)
    Assoc with vision loss

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