Case Presentation PK19조 김대진

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

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 2007-04-20 OP위해 본원 입원

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

L`hermitte sign (+) spurling sign (+)

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

Pre op MRI (4/11) T2W Mid saggital

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

Diagnosis & Treatment # C5-C6 HNP  ACDF

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

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

P/E for cervical radiculopathy

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

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

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

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

Reference Orthopedic physical assessment David J. Magee 4th edition p121-175 Chapman`s orthopedic surgery 3rd edition volume 4 p3747-3760 척추외과학 – 개정 신판, 석세일, 최신의학사 p172-190