CERVICAL HYPOLORDOSIS: A CASE STUDY OF TREATMENTS AND OUTCOMES

EMILY ZIPOY, MATHEW KALAPURAYIL, RHONDA CROSS BEEMER PHD, ATC (MENTOR)Drake University College of Pharmacy and Health Sciences

RESULTS OF DIAGNOSTIC IMAGINGMRI and radiographRevealed a chronic history of reverse cervical spine curvature and osteophytes along posterior and lateral vertebral bodies C5/C6.

REFRENCES

1. Olson, V. L. (1007). Whiplash- Associated Chronic Headache Treated with Home Cervical Traction. Physical Therapy , 417-424. 2. Schenkman, M. (1996). relationships between mobility of axial structures and physical performance. Physical Therapy , 3 . 3. http://www.coralvillechiropractic.us/photo.htm 4. http://www.med.nyu.edu/hjd/hjdspine/education/problems/neckandarm/cervicalspond.html 5.McKinley, Michael P., and Valerie Dean. O'Loughlin. Human Anatomy. Boston: McGraw-Hill Higher Education, 2008. Print.6. http://occaraccident.wordpress.com/2009/10/02/do-you-know-the-most-important-physical-sign-to-look-for-after-a-car-accident-in-orange-county-ca/

* : Images used in this poster are not from this particular case study and do not represent the studied patient. Images are being used to supplement the presented information and provide visual representation of the different aspects of this particular case study.

ABSTRACT BACKGROUND: Cervical hypolordosis is a condition affecting the cervical vertebrae in which the normal anterior curvature shifts posteriorly from its original position, creating a flattening, causing pain and neuropathy in patients. Little data exists on the causes, treatment, and progression of this condition which gives motive for this case study.

CASE PRESENTATION: A moderately active 51 year old female patient sought chiropractic treatment after experiencing numbness in the 3rd, 4th, and 5th digits of the left hand. She was diagnosed with a strain within the supraclavicular region. A hypolordotic curve of the cervical vertebrae was noted upon visual examination. Treatment using chiropractic techniques led to 90% pre-injury strength. The patient later returned with further neuropathy signs and symptoms. A differential diagnosis included thoracic outlet syndrome or disk herniation of the cervical vertebrae. An MRI revealed reverse cervical curvature and osteophytes along the lateral bodies of C5/C6 vertebrae.

TREATMENT: A treatment plan and protocol was followed addressing biomechanical changes utilizing chiropractic adjustments, proprioceptive neuromuscular facilitation, stretching exercises, and a home exercise program.

CONCLUSION: Within only four treatments over a 2-week rehabilitation program, using therapeutic exercises and chiropractic adjustments, a 90% self improvement of symptoms was reported by the patient. With so little evidence about cervical hypolordosis, it is important to note the positive outcomes of this patient and to utilize the information to treat and/or educate others who suffer from cervical hypolordosis.

PERSONAL DATA/PERTINENT MEDICAL HISTORY51 year old moderately active female presented with 3rd, 4th, and 5th digit numbness after performing a pectorals deck exercise (June 2010) Initial examination revealed:

Hyperactive deep tendon reflex in the left bracioradialisPain in the left elbow and hyperesthesia of C6 and C7 dermatomes

Mild left arm supination and pronation weakness Elbow flexion with resistive range of motion.

Patient would later return in November 2010 with exacerbating symptoms

PHYSICAL SIGNS AND SYMPTOMSFirst visit

Positive bilateral Cervical Jackson’s compressions testPain in left subclavicular regionHypertonicity within the right supraclavicular and cervicothoracic region. Complaints were reproduced with left elbow lateral to medial compressionDiagnosed with a strain or sprain within the supraclavicular region that manifested as radiating numbness

Second Visit Shooting pain in right tricep and lateral forearmReturn of digit numbness (3rd, 4th, 5th)Unknown mechanism of injury Pain was a gradual onsetNormal deep tendon reflex responsesPoint tenderness within the right C4-C6 spinal region with active trigger points in supraspinatous and supraclavicular regions Increase in symptoms with passive and active range of motion of cervical lateral flexion

DIFFERENTIAL DIAGNOSISFirst visit

Cervical hypolordosisCarpal tunnel syndrome Supraclavicular strain

Second VisitThoracic outlet syndrome Disk herination.

CLINICAL PLAN & PROTOCOLSThe below plan was performed over a 2 week period with the hope of the patient continuing the home exercise program.Chiropractic adjustmentCombination ultrasound and electrical muscle stimulationIce massage Wrist brace to wearProprioceptive neuromuscular facilitation Active isolated stretchingMyofascial releaseHome exercise program

Isometric contract/relax cervical extension exercises, static extension, bilateral lateral flexion and bilateral rotation stretches.

BACKGROUND Cervical hypolordosis, commonly referred to as "flat neck" or "straight neck," is a term used to define loss of curvature in the cervical spine. Usually the neck has a lordotic curvature, which is minimally present or even absent in hypolordosis. There are varying theories and speculations as to why this abnormality occurs. Previous studies have attributed it to abnormal development of the spine during embryogenesis, trauma from motor vehicle collisions(MVCs) or a sporting accident ,1 as well as chronic back pain and neurologic disorders. Over time these events can lead to poor postural alignment2; the most common cause for cervical hypolordosis 2.

The purpose of this retrospective case report is to review treatments and outcomes of a patient diagnosed with cervical hypolordosis due to limited research pertaining to cervical hypolordosis. This poses a significant problem for clinicians in treating the disorder.

CONCLUSIONDiagnosed with cervical hypolordosis with osteophytesSupraclavicular strain impingement of nerves pain and numbness.Patient experienced dermatome numbness and hyperexcitable deep tendon reflexes Assessment techniques used to narrow diagnosis possibilities.Treatments focused on managing cervical hypolordosis and supraclavicular strainPatient rapidly improved and was released from care after few treatmentsNot reassessed for change in cervical angle before being discharged.Patient left with knowledge and ability to perform home exercise program.

*Figure 1: Cervical Hypolordosis 3*Figure 3: Osteophytes along cervical spine 4

*Figure 5a: Radiograph of cervical spine from initial visit indicating cervical hypolordosis

(Before treatment ) 6

*Figure 4: Dermatome Map 5

*Figure 5b: Radiograph of cervical spine curvature after treatment therapies 6

*Figure 2: Cervical Jackson Compression Test