Case Presentation PK19조 김대진.

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1 Case Presentation PK19조 김대진

2 조OO, 35/M (2359962) Chief complain
Pain on neck (radiate to both arm and interscapular area ) Radiating pain: Lt>Rt

3 Present illness 내원 6개월전 경주 자동차 정비 공장에서 자동차 밑에서 정비 중에 일어나다가 목을 부딪히며 수상
정비 중에 일어나다가 목을 부딪히며 수상 입었고 내원 5개월전 포항 사랑 척추 전문병원에서 C5-6 HNP 진단 하에 5주 입원하여 conservative management 받았으나 호전 없어 OP위해 본원 입원

4 Physical examination Extremity  Neck    Tenderness : C5-6  Lt. arm    swelling/tenderness  -/-  Lt. hand      clumsiness(-)    finger escape sign (-)    grip and release test            Rt./Lt.  #26/10s  #20/10s    M/S/C - intact

5 L`hermitte sign (+) spurling sign (+)

6 Pre op AP Lat view (4/11) AP Lat

7 Pre op MRI (4/11) T2W Mid saggital

8 Pre op MRI (4/11) T2W axial (C5-6)

9 Diagnosis & Treatment # C5-C6 HNP  ACDF

10 Post op AP Lat view (4/24) AP Lat

11 Physical Examination of Cervical radiculopathy
Disease Review Physical Examination of Cervical radiculopathy

12 P/E for cervical radiculopathy

13 P/Ex. for cervical radiculopathy
Spurling’s sign Axial compression test Shoulder abduction relief sign Distraction test

14 P/Ex. for cervical myelopathy
Hand clumsiness – 부자연스러운 손놀림 Hoffman reflex - C5,6 Grip and release test - 10초당 20회 이하시 (+) L’hermitte’s sign - (+) : 팔, 다리로 shooting, electric- like pain Finger escape sign - Finger adduction, extension (pyramidal tract sign ) 상태로 30초이상 유지 못함 Inverted radial reflex - (+) : wrist & finger flexion (C6) (-) : wrist dorsiflexion brachioradialis tendon reflex 감소

15 Cervical radiculopathy vs myelopahty
Cervical myelopathy Arm pain in dermatome distribution Hand numbness, head pain, hoarseness, vertigo, tinnitus, deafness Spurling`s sign (+) L`hermitte`s sign (+) Pain may be relieved by putting hand on head (C5,6) Arm positions have no effect on pain Sensation affected Gait not affected Wide-based gait drop attacks, ataxia

16 Altered hand function Loss of hand function (clumsiness) Weakness in myotome but no spasticity Spastic paresis( 초기-하지, 후기- 상지) Bowel and bladder not affected Possible loss of bowel and bladder control DTR - hypoactive DTR - hyperactive

17 Reference Orthopedic physical assessment David J. Magee 4th edition p Chapman`s orthopedic surgery 3rd edition volume 4 p 척추외과학 – 개정 신판, 석세일, 최신의학사 p