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Forum Name: Spinal problems and back pain

Question: Diagnosing a Neck Injury


 stormytwo - Sat Jan 03, 2009 9:22 pm

I am a 49 year old female with no other known illnesses other than depression or extreme fatigue which lasts. I have had it since I was 37. I may have had adult mono about this same time and then I got a thyroid cyst. The only medicine I take is Wellbutrin---it gives me energy.

How do orthopedic doctors know if a person's neck or back is truly injured if there are no broken bones I ask this because people can say they have headaches or neck aches say from a fall or an accident---like a car accident say the rear end accident---but if no bones are broken how else can you tell?

I have been in car accidents in which I was in a car hit from behind a few times in my lifetime. Each time---I didn't feel pain until a day or so later which began with a headache which would subsided with Motrin, but once the Motrin wore off---the headache was back. Within a few days of taking the Motrin---the pain seemed to get worse and the pills would not even help. I told the doctor and he sent me for physical therapy in each instance. If everyone gets degenerative disease as they age, and it shows up in x-rays, then can't it be said that the person's neck or back hurts because they have the beginning of degenerative disease instead of because they were rear ended. Is there a way the doctor can recognize the difference?
 Tom Plamondon PA-C - Mon Jan 05, 2009 12:09 pm

User avatar You have asked some good questions.

With motor vehicle accidents in which the victim suffers a whiplash injury to the neck, it is common for the neck to present with latent pain. The mechanism usually does not cause fractures or disc bulging (unless it is very high impact). The tissues around the vertebrae over stretch and become inflamed causing localized swelling, pain, and stiffness. Headache can occur too. The symptoms can last for months and even years. Some patients have even reported symptoms of chronic fatigue syndrome and migraine headaches.
Treatment includes maintaining normal range of motion; easing the pain with hot or cold packs, NSAIDS, and massage; maintaining good posture and general health including diet and exercise.

Injury to vertebral bone, joints, and disks can be determined by history, physical exam, and tests (xray, MRI and sometimes bone scan or CT). Depending on the severity, injury to soft tissue (tissue other than bone,joints, and disks) around the spine may be harder to spot on an imaging test. In this case, we rely on the history and physical exam and response to treatment.

To answer the question about degenerative changes in the spine. Most people will develop degenerative changes (bone spurs, decrease height of vertebral column, bulging discs) in the spine over their lifetime but many people do not suffer from long lasting spine pain. Thus degenerative changes do not neccesarily cause spine pain.

One of the dilemmas in diagnosing spinal conditions after an injury is when the imaging tests show mild degenerative changes and the patient has symptoms in the neck, head, or limbs. For example, is the pain resulting from what the MRI reports says "a mild bulging disk" (degenerative change) or is it from another structure.

Age of the patient matters too.

On imaging, we look for changes from previous testing; we look for moderate or severe deformities (eg bone spur or disc bulge narrow the spinal canal); and we try to correlate the imaging findings to the clinical symptoms. Does what the MRI show match the patients symptoms.

Hope this helps.

Keep us posted.

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