This topic contains 3 replies, has 3 voices, and was last updated by 
Jamie Hansen March 13, 2019 at 3:20 pm.
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Jamie Hansen
Hi Everyone,
This is my first time posting, Im working with Dr. Chris Stepien as the neck specialist in his office. After reviewing a case with him he recommended that I post this to discussion board so here we go:1st Order Hx Points:
Age 37
Sex M
L a)R neck, b)R mid-scapular, c)L 3/4/5 fingers
Q a/b) achy, stabbing, burning/throbbing c) pins and needles
I rest: 3/10 worst: 8/10
P+ Neck movement specifically R rot, ext, L Lat flex, R shoulder retraction, Skeet shooting
P- reclining, laying downDiagnostic Hypothesis:
disc C6/7, C7/T1, adhesion, t-spine disc2nd Order Hx Points:
History of H/X 5-7x wk –> tension at the base of the skull
can radiate, but only to the R around the skull to the front in his forehead.7yrs ago fell on ice (as he put it looked like the cartoon style slip like he stepped on a banana peel) landed on right upped mid thoracic (did not hit head) sore for a few days nothing much post.. ~5 months later ” i was throwing my friends kid in the pool” when i got a sever spams in my right C/spine trap area. that pain increased to a numbing, burning, stabbing right med scapular. the following am he woke up with this 3,4,5, digits tingling and numb (Left)
Re-worked Diagnostic Hypothesis?
C6/7, C7/T1 disc.
Exam:
UCF: 6/25 –> reproduced 3,4,5, radicular pain
CF: 13/60 –> reproduced 3,4,5, radicular pain
CTF: 37/90
Rot: L 49/90 R 47/90
Lat Flex–> R with shoulder depression reproduced finger s/xQuestions:
Today was his 6th visit, his UCF has gotten to 12 and CF has gotten to 44
however after the 3red treatment he suffered a “massive migraine” after that “knocked him out for the rest of the day and 1/2 of the follow day. After the 4th visit he sustained a mild regular H/A that went away shortly after, and after this 5th visit he had a regular mild HA however it evolved into a “mild migraine” but resolved by the follow am.Is this normal (H/A post TX)? Has anyone experienced a case like this? He will hopefully be getting an MRI in the next week or so, and we decided today after tx that if he has another “migraine” to hold off on his Thursday appointment until his MRI, if its a “regular HA” he will come in on Thursday.
Thank you everyone in advance for any input.
Joe
Logan Scharf
Thanks for posting Joe –
You mentioned after his sixth treatment he has improved UCF and CF. My question is have you been trying to treat both tests for this patient in the same visit? With this patient having a history of headaches multiple times a week his capacity to withstand treatment will pry be very low, and trying to treat multiple areas will flare up symptoms easily. I have had many patients with similar presentation and care is very slow to begin with in order for them to be able to adapt to the treatment dose.
Seth Schultz, DC
I agree with Logan. This guy has massive limitations in the cervical spine. The treatment dose is like too high and flaring up the underlying pathology. Getting the MRI will help change your prognosis and manage your treatment accordingly.
When you look at his CF being tripled in 6 visits that is a massive jump and his tissues need to time to accommodate. This could also be he’s having increased symptoms. Load management will be extremely important going forward. Great job improving the test so far!
Jamie Hansen
Thank you Logan and Seth for your feed back its makes complete sense to me.
One thing i forgot to mention we stoped working on UCF after the massive migraine and moved on to CF. That is why he has shown improvements with that test. I was not treating both areas at once.
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