It's common for patients to have neck, back pain, and whiplash after a car crash or similar injury. Interestingly during the exam process I frequently uncover additional previously undiagnosed injuries.
People seem to ignore areas of the body like the shoulders, wrists, hips, or other joints. These hidden injuries often contribute significantly to the patient's ongoing discomfort.
This brings us to two pivotal questions:
As a car accident chiropractor understanding what is causing a patient’s pain is crucial. First, let's examine the reasons why the initial visit might not fully diagnose some injuries.
Upon their first visit, patients with neck pain, back pain, or whiplash symptoms post-accident undergo a comprehensive neurological and orthopedic evaluation.
This includes checking the neck and upper extremities for:
The back exam also checks hips, knees, ankles, and feet for similar symptoms and reflexes to find spinal injuries.
The exam aims to find all injuries by assessing them thoroughly and efficiently, despite having many details. The examination aims to find all related injuries. A thorough and efficient assessment achieves this.
Despite having many details the examination remains focused on this main goal.
The foremost reason for missed diagnoses is the absence of a complete examination. Injuries can be present even in areas where the patient does not experience pain, thus requiring a detailed examination.
Additionally failing to perform necessary X-rays can lead to overlooked fractures. However, even with a thorough examination and imaging some injuries still go unnoticed.
After experiencing trauma especially concerning the neck a car accident chiropractor may also order flexion and extension X-rays. These dynamic X-rays are instrumental in assessing the range of motion and detecting any abnormal vertebral movement.
Static X-rays may not reveal ligament injury or instability.
Furthermore, these X-rays are valuable in evaluating potential soft tissue injuries and instability in the neck. This step ensures the most accurate diagnosis from the beginning.
"Soft tissue" means different tissues in the body that connect, support, or cover organs and bones.
While people often use the term 'soft tissue' to refer to muscle-related issues, it also includes injuries to:
Soft tissue injuries might manifest as contusions, sprains, or tendonitis. Communicating with your car accident chiropractor is important. This will help determine which tissue is causing your pain. Identifying the specific tissue is crucial for effective treatment.
Soft tissue injuries involve muscles, ligaments, and nerves. However, they heal differently and respond to trauma in various ways.
A proficient provider should understand the importance of recognizing these differences tissues when addressing trauma-related injuries.
After an accident, it is common for neck or back injuries to cause muscle spasms in those areas.
Such spasms can be intensely painful and restrict the patient's movement. The car accident chiropractor needs to exam the patient once the muscle spasms have subsided. Ensuring that we identify and document all injuries is important.
Typically, we conduct a follow-up exam within 2-4 weeks. Most muscle injuries should resolve within 4-6 weeks of care.
Afterwards, the doctor may need to order more tests like an MRI and extra X-rays if there isn't significant improvement.
MRIs, Ultrasound, X-Rays, and digitized X-Rays can find hidden connective tissue and disc injuries. These imaging techniques are useful in identifying hidden injuries.
Ligament injuries can cause neck pain and spasms that reach the shoulder blade. These symptoms may seem like muscle pain, but they could actually be hiding sprains or ligament injuries.
Hence an accurate initial diagnosis followed by a thorough re-examination is critical with your car accident chiropractor.
Neck pain spreading to the shoulder blade might be a ruptured facet capsular ligament (FCL).
FCL rupture can lead to:
This scenario might necessitate intervention from a pain management specialist, a coordination that your car accident chiropractor can facilitate.
Recognizing that a cervical facet injury can cause radiating pain to the shoulder blade is important.
This approach guarantees that we conduct the right tests and provide appropriate treatments, ultimately detecting all injuries.
Understanding the distinction between a sprain and a strain is crucial for accurately diagnosing injuries. While 'soft tissue' is a broad term encompassing muscles, ligaments, and nerves, it doesn't specify the exact source of pain.
Pain can come from muscles and ligaments, but not telling them apart can lead to missed diagnoses.
In terms of diagnosis:
A skilled provider should be adept at identifying this distinction.
We classify sprains into three grades, with each grade signifying the severity of the ligament tear.
Medical research shows that grades 2 and 3 sprains have long-term effects because the ligament doesn't fully heal. Instead it undergoes wound repair and forms adhesions, this makes the joint unstable.
Similarly, sprains at all three grades can result in lasting damage to the ligament.
Pain following neck and back injuries generally stems from five main sources:
People who experience neck pain after an accident typically receive treatment for muscle pain. This treatment often involves physical therapy and may also include seeing a chiropractor who specializes in car accident injuries.
Radiologists commonly perform MRI's early on based on exam findings. Quickly diagnosing a herniated disk is crucial when seeing an experienced chiropractor for injuries caused by trauma.
MRI accuracy can differ based on where it's done and the radiologist's expertise in interpreting it.
Disk herniations are easier to diagnose because they cause specific pain in the neck and arms.
Consequently, doctors rarely miss the diagnosis of disk herniation because they frequently use MRIs promptly.
On the other hand, facet and ligament pain in the neck or back are often not as readily identified.
Doctors commonly miss or under-diagnose these types of pain. These conditions can present a greater challenge in the management and diagnosis.
Facet joint pain can be difficult for your car accident chiropractor to treat, sometimes needing advanced imaging for diagnosis.
Treatment options range from conservative care to more advanced interventions like steroids, radiofrequency ablation, or emerging biologic treatments.
While treatments like steroids or RFA's can alleviate pain, they may not restore normal function in the facet joint. In contrast biologics have the potential to not only address pain but may also repair tissue damage.
Various studies have identified the facet joint as a source of pain in patients suffering from chronic whiplash disorders.
This 2021 research suggests that instability in the facet joint, possibly due to capsule rupture could be a key factor in the persistence of symptoms and lack of recovery in these patients.
Ligament pain, especially in the sacroiliac and hip joints, is a commonly missed injury in and around providers.
Not doing certain imaging tests like MRI and X-rays to check spinal movement can cause missed diagnoses.
Your car accident chiropractor should tell you that ligaments take longer to heal than muscles. Some studies suggest that a damaged ligament may need up to a year to fully heal.
Another set of commonly missed injuries involves the sacroiliac and hip joints. These injuries can result in unilateral low back and groin pain. Thorough examinations of both the hip and sacroiliac joints are essential.
Distinguishing sacroiliac joint pain from spinal pain is crucial.
In cases of hip pain associated with groin discomfort, an MRI, often accompanied by an arthrogram may be necessary for accurate diagnosis.
This imaging can help identify issues like labral tears, which might necessitate surgical intervention.
Proper imaging and examination techniques are crucial for accurate diagnosis and effective treatment. Ligament injuries often require longer healing times compared to muscular injuries.
From my experience the most commonly overlooked injuries include:
Some injuries from accidents or trauma are often missed, but the ones mentioned are usually ignored.
To reduce the chance of missing these injuries, it's important for your doctor to be well-trained in trauma injuries.
Additionally, if a patient's symptoms don't improve with care within the first 4-6 weeks, it's advisable to conduct further examinations and possibly more diagnostic studies.
Healing trajectories vary depending on the tissue involved. The main goal is to help the patient get better fast and stop a hidden injury from becoming long-lasting.
Chronic injuries typically result in greater disability and are more challenging to treat effectively.
