Upper Cervical Ligamentous Disruption in a Patient With Persistent Whiplash Associated Disorders

James M. Elliott, Jason Cherry

DOI: 10.2519/jospt.2008.0406

The patient was a 51-year-old female with persistent pain resulting from 2 rear-end vector motor vehicle accidents 7 years ago (head turned at impact during the second motor vehicle accident). She self-referred to our physical therapy practice with symptoms that included constant neck pain, dizziness/unsteadiness, fatigue, and self-reported anxiety. Active cervical range of movement was also notably reduced and reproduced "clunking" in the upper cervical region. Based on the patient's history and examination findings, the physical therapist was concerned about the possibility of upper cervical ligament damage. It was suggested to her physician that proton-density weighted magnetic resonance imaging be performed. The radiologist's findings led to the commencement of physical therapy aimed at addressing range-of-motion deficits, pain, and motor control of the cervical region. After 4 months, the patient reported feeling less anxious and more stable, with less mechanical clunking, and is now able to engage in daily activities with less pain and fatigue.

J Orthop Sports Phys Ther. 2008;38(6):377. doi:10.2519/jospt.2008.0406

KEY WORDS: magnetic resonance imaging, neck pain

The patient was a 51-year-old female with persistent pain resulting from 2 rear-end vector motor vehicle accidents 7 years ago (head turned at impact during the second motor vehicle accident). Magnetic resonance imaging was used to assess the patient, and physical therapy was subsequently structured based on those results.

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