Case 3- A 44-year-old female presented whose first onset of neck pain resulted from a motor vehicle collision in 1978.

She was out of work for 6 weeks and received care for approximately 1year in the form of medications, hot packs, and ultrasound. She had experienced intermittent symptoms since the accident. In 1991 she presented for chiropractic evaluation, about 2 years after her neck, thoracic, and right shoulder pain had worsened. Her complaints were aggravated by repetitive motions at work and she had been put on temporary disability. Findings included a decrease in grip strength on the right of 40% (rt. dominant) and paresthesias in her right elbow and right middle and ring fingers. A nerve conduction study showed some slowing of the ulnar nerve conduction bilaterally at the elbow. Cervical spine range of motion showed her to be able to flex her neck sp that her chin 2" from her chest. Extension was limited to 15 , left lateral bending to 25 , right lateral bending to 35 , right rotation to 60 , and left rotation to 50 , with increased pain on lateral bending and rotation. The right biceps reflex was slightly decreased in comparison to the left (+1). Cervical compression produced right-sided neck pain.

Hyperextension compression produced neck pain bilaterally. Shoulder depression produced pain on the right, and Adson's test decreased the pulse on the right. She ahd been taking medications and drinking large mounts of alcohol in attempts to decrease her pain. Because of her pain (8 on a 1-10 scale), she had not workd for the previous 2 months.

MRI findings of January 1992 indicated interspace disc narrowing at C4-C5, C5-C6, and C6-C7. At C5-C6 there were posterior and posteriorlateral osteophytic spurs, more prominent on the right side relative to the left which were causing moderate foraminal narrowing on the right. Plain film X-ray films indicated hypolordosis, early right C4-C5 facet arthrosis, and a moderately restricted range in extension and flexion with slight retrolisthesis of C5 on C6. Due to her history of alcohol consumption, a greater depth of anesthesia was required. A combination of versed, diprivan, and anectine was utilized. After 1 month of follow-up with eight treatments consisting of cervical and thoracic manipulations, electrical muscle stimulation, and ultrasound, the patient claimed to have no physical complaints. Cervical flexion was 1" chin from chest, extension ws 30 , lateral flexion was 40 on the left and 45 on the right, and rotation was 80 to both sides. Reflexes were 2+ and her orthopedic tests were negative. She was dismissed from care without residuals and ?or disability. After 1 year she presented for follow-up and reported no complaints.