ELMWOOD PARK CHIROPRACTIC
& PHYSICAL THERAPY
511 BOULEVARD
ELMWOOD PARK, N.J.07407
201-796-5273
FAX-201-796-8645
Michael Schill, Jr, DC, PC
Scott Bensky, DC
Linda A. Williams, RPT
May 6, 2008
Narrative Report
Law Firm
511 Boulevard
Elmwood Park, N.J. 07407
Attn: Office manager
RE: Beverly Simms
DATE OF ACCIDENT: December 11, 2006
Dear
,
Beverly Simms reported to our office on December 17, 2006 for
examination and care for injuries resulting from an automobile
collision which occurred on December 11, 2006 in which injuries to
the neck and low back were sustained.
PATIENT SYMPTOMS
neck pain /stiffness
mid back pain/stiffness
low back pain/stiffness
pins and needles in arms bilaterally
radiating pain in both buttocks
pain radiating into the right leg
PATIENT HISTORY
The patient's past history is noncontributory. Ms. Simms
denies any prior problems or injuries.
EXAMINATION FINDINGS
Customary physical orthopedic, neurological and x-ray
examinations were performed and revealed the following.
The patient, a female of 38 years of age, was last examined
On June 12,2007.
Pulse 74 ppm. Blood Pressure 128/80. Temperature NTT.
Re: Beverly Simms
Page 2
Demeanor: relaxed
Respirations: normal
The patient ambulates guarded.
The patient walked with difficulty on heel & toes.
Posture: protective
Visual postural evaluation noted the following:
The occiput was level.
The shoulders were low on the right.
The iliac crest was low on the right
From the side/lateral view it was noted that the head was
anterior to the midline, thoracic region was normal, and lumbar
region was hypolordotic.
CERVICAL SPINE:
Examination of the cervical spine revealed the following:
Tenderness upon digital palpation of the occiput C1 area,
Cervical motion studies revealed:
Normal
12/17/06
flexion
65
35
extension
50
30
left rotation
85
45
right rotation
85
40
left lateral flexion 40
20
right lateral flexion 40
25
6/12/07
55
45
55
60
30
35
Sensory evaluation on both arms revealed: decreased sensations in the
right arm along the C5/C6 dermatome bilaterally
Bicep tendon reflexes were equal and active
Tricep reflexes were within physiological limits
The Brachial Radialis reflex was within physiological limits
Muscle testing for the motor function of the Brachial Plexus
revealed a weakness of the biceps muscle on the right side
The Foraminal Compression tests were positive.
The shoulder depression test was positive bilaterally.
Cervical Distraction test was positive
Soto-Hall was positive
Re: Beverly Simms
Page 3
THORACIC SPINE:
Examination of the Thoracic spine reveals the following:
Tenderness upon palpation of the T1 to T9 spinal levels was
present. Palpation of the thoracic spine revealed tenderness and
muscle spasm of the paravertebral musculature bilaterally.
LUMBAR SPINE:
Palpation of the lumbar spine reveals pain, tenderness and muscle
spasm of the paravertebral musculature bilaterally at L2 to S1
spinal levels. The location of radicular pain was into both hips.
Pain was further aggravated by coughing, sneezing, straining at stool,
bending and lifting, and rising from a seated position.
Minors sign was negative.
Valsalva sign was positive for leg pain.
Spinal tilt test was positive to the right side.
The lordotic curve was observed to be decreased.
Lasegue test was positive and demonstrated radicular pain along
the sciatic nerve distribution at 25 degrees on the right.
Bragard's test was negative for lumbar pain on the right side.
Fabere-Patrick test was negative.
Goldthwait's test was after lumbar movement differentiating
lumbar involvement respectively.
Pressure applied to the apex of the sacrum with patient in prone
position produced radiation of pain into the buttocks bilaterally
at L4/L5 spinal levels.
Lumbar motion studies revealed:
Normal
12/17/06
flexion
95
60
extension
35
15
left lateral flexion
40
20
right lateral flexion
40
25
6/12/07
75
30
30
30
Deep tendon reflexes were equal and reactive.
Pinwheel tests on the lower extremities were within normal limits
Re: Beverly Simms
Page 4
The muscle strength test for the intrinsic muscles of the pelvic
and lumbar spine demonstrated weakness of the quadratus on the
right side, gluteus medius on the right side.
RADIOGRAPHIC EXAMINATION
Radiological- X-rays taken December 11, 2006 at St. Josephs Hospital in
Paterson:
1. Chest- negative study
2. Pelvis- no evidence of fracture
3. CT Scan abdomen- no significant abnormalities noted
4. CT Brain-examination within normal limits
5. CT Cervical Spine-no fractures or subluxations/probable muscle
spasms
6. CT Pelvis- no significant abnormalities noted
MRI FINDINGS
MRI Cervical Spine done January 28, 2007 shows central disc bulge at
C5-C6
MRI Lumbar Spine done January 28, 2007 shows central bulge L5/S1
The full report is attached to this report.
DIAGNOSIS
1 723.3
2 729.2
3 722.0
4 729.1
5 729.2
6.724.4
Cervical Brachial Syndrome
Cervical Neuralgia
Cervical Disc Syndrome
Thoracic Neuralgia
Lumbar Neuralgia
Lumbar Radiculitis
CONDITION
In this a traumatically induced injury over an already weakened area of
the cervical and lumbar spine. I am of the opinion there has been an
injury with compression trauma to intervertebral disc at C5/C6 level
and the L5/S1 level resulting in dyscopathy. This narrows the
neurological openings and produces nerve root compression. The
connective tissue has been stretched, causing laxity and tone loss.
When supporting tissue becomes lax, it gives rise to spinal
instability. This unstable condition allows misalignment of the
vertebral bodies and posterior joints, and the involved spinal segment
then compresses omitting posterior nerve roots by a pincer type
movement. Nerve root compression has caused radicular pain. The
subsequent pain causes muscles supporting the injured area to spasm and
splint in an effort to immobilize the area as a protective mechanism
from further aggravation. The formation of scar tissue at the injury
site has caused a loss in the normal range of motion because of the
loss of the elasticity which is evident on the neurological and
orthopedic testing.
Re: Beverly Simms
Page 5
Chronic dyscopathy causes a fissure to be formed through the
consecutive layers of the annulus fibrosis causing the nucleus to
move toward the periphery. This irritation will ultimately cause
the disc to take on a more wedge shaped position. Eventually
abnormal weight bearing and uneven wear will cause a pressure
atrophy so there is a possibility that the entire thickness of
the involved disc will become diminished. The disc will
eventually become degenerative in its superior to inferior
thickness, producing a chronic subluxation syndrome.
TREATMENT
Treatment to date was of a conservative nature consisting of mild
spinal manipulation and physiotherapy in the form of: galvanism,
neurological re education and massage of the cervical and upper
thoracic musculature. The patient also underwent a course of physical
therapy and manipulation under anesthesia in an effort to stabilize the
area.
PROGNOSIS
The prognosis of this injury is poor.
The probability of future or persistent neurological deficits is
likely, so the prognosis for this group is guarded. The above
patient suffered substantial ligamentous damage due to this
accident. Clinical facts that further degenerative changes are the
inevitable response of ligamentous and capsular injury. The
formation of marginal hypertrophic spurs about the lateral
Intervertebral space are the primary discogenic spondylosis
changes. Concomitant with the above, articular adhesions will
form on the posterior diarthrosis type joint restricting
fascicular sliding and alter the motoricity of the segment within
the bed. These changes cause foraminal narrowing and are
responsible for future nerve root irritation and resultant
pathological subluxation degeneration of that motor unit.
The healing prognosis of this injury will leave structural
weakening this patient's cervical and lumbar spine. This patient will
experience cervical and lumbar pain from time to time, even after being
released. The frequency is dependent upon may variables.
Although the condition is still highly unstable, it appears the
maximum level of stability and maximum medical improvement has
been achieved. This patient is predisposed to further
recurrences.
Sincerely yours,