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Doc I Just Yard-saled Now I Can't Sit Back And Text - Page #1
 

Author: Nicholas Molby, DO
Co Author #1: Theodore Paisley, MD
Co Author #2: Jordan Knox, MD
Senior Editor: Carolyn Landsberg, MD
Editor: Adam Lewno, DO

Patient Presentation:
A 45-year-old male was brought to clinic by Ski Patrol with concern for left elbow fracture after a skiing accident.

History:
The patient reported his ski caught an edge, and as both skis released, he fell forward performing a somersault in which he landed on his neck. He denied any neck or back pain as well as any prior injury to his neck, back, or left arm, but endorsed a burning pain in his left elbow and forearm with radiation down to his left second and third digits. He also denied any symptoms in his other extremities. X-rays of his elbow were unremarkable. While awaiting the radiology report, it was noted that the patient had weakness holding his arm in front of his face while reclined. Palpation of c-spine was repeated, and tenderness was noted along the left lateral process of C6. A C-collar was applied and the patient was transferred to the hospital for advanced imaging.

Physical Exam:
General: No distress
Cardiovascular: Normal
Pulmonary: Normal
Abdominal: Normal
Neuromusculoskeletal:
Neck:
Alert and oriented to person, place, and time.
Nontender to palpation of the midline cervical spine, but tenderness along the left lateral C6 mass, reproducing paresthesias.
Reproduction of pain and paresthesias down left arm with left neck side bending.
Left Upper Extremity:
No deformity.
Tenderness proximal to lateral epicondyle, and no tenderness along the left clavicle, shoulder, or wrist.
Full range of motion in the shoulder, elbow, and wrist.
Strength was 5/5 throughout the arm except 4+/5 biceps and 4/5 triceps.
Deep tendon reflexes were 2+ brachioradialis, biceps, and triceps.
Serial examination found the patient unable to hold his left elbow in extension while texting overhead from a reclined position.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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Phone: 913.327.1415


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