Baltimore Car Accidents and Peripheral Nerve Injuries

Baltimore Car Accidents and Peripheral Nerve Injuries

As a Baltimore chiropractor that spends a lot of time treating patients involved in Baltimore car accidents with Baltimore whiplash injuries, I see many “non traditional” presentations of injuries. That is, I will treat patients for several weeks and they may fail to improve as expected. They continue to have arm or leg symptoms such as numbness, tingling, or weakness in an extremity. In these instance I will typically refer my patient for advanced imaging such as MRIs or CT scans to better characterize their injuries. I would typically expect to see disc inflammation, disc protrusion/extrusion/herniation, and or ligament or tendon tears. Once in a while these expected findings do not appear on imaging. In these instances I typically refer my patients to a neurologist for a second opinion.

Neurologists are able to perform a series of studies such as NCVs and EMGs. These are tests where needles are placed near the spine and down the arms and legs where the spinal nerves travel. These tests attempt to determine where along the pathway of a nerve there is a decrease in nerve impulses that correlate with a patient’s symptoms.

Whiplash injuries can cause injuries to peripheral nerves. A tractioning of the brachial plexus (the collection of nerves that exit the neck and innervate the arms) or the lumbosacral plexus (the collection of nerves that exit the lower back and innervate the legs) can lead to arm or leg symptoms following whiplash injuries due to the rapid acceleration and deceleration forces involved in these crashes.

Research out of the Journal of Bone and Joint Surgery in 2001 state that “symptoms and signs attributable to stretching of the brachial plexus do occur in a significant proportion of patients after a whiplash injury. Their presence and persistence are associated with a poor outcome…”

When treating patients involved in whiplash injuries in Baltimore, it is important that patients treat with providers that not only know how to help them feel better, but how to appropriately document the full extent of these injuries. Depending upon the normal ADLs that a patient has to perform in their lives and/or their jobs, peripheral nerve injuries can cause permanent impairment and in some cases may require an injured individual to find another vocation.

If you, or someone you know, has suffered a peripheral nerve injury as a result of a Baltimore car accident and have suffered Baltimore whiplash, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Baltimore Whiplash Injuries Worsened Due to Cervical Spine Stenosis

Whiplash injuries in Baltimore, MD are very common injuries due to the sheer number of rear-end motor vehicle collisions in Baltimore. Most of the time these injuries are self limiting and patients respond well to several weeks of chiropractic manipulation, electric muscle stimulation, passive modalities, intersegmental traction, and active therapeutic exercises. Sometimes some patients do not respond as well to care even in instances where the impact to a vehicle is not very severe.

Most patients that present for whiplash treatment in Baltimore have some form of prior injury or pre-existing condition. They have either had prior crashes that resulted in cervical spine (neck) trauma or they have some form of pre-existing injury in their neck that makes them more susceptible to injury even in response to minimal acceleration forces in minor crashes.

One condition that I see frequently is cervical spine stenosis. This is a condition where the sagittal neural canal diameter (where the spinal cord and its surrounding connective tissues normally sit) is already smaller than usual. Patients can have cervical spine stenosis and have no symptoms of it in the absence of trauma. Generally speaking cervical spine stenosis is largely a result of aging and of having advanced arthritis of the neck and is present in elderly patients (middle age and beyond). In these patients even minimal amounts of cervical disc bulging and/or inflammation in the neck following Baltimore whiplash injuries can result in severe neck pain, and in some cases, neurological symptoms such as numbness, tingling, and/or weakness down either one or both arms.

Research from Debois, Herz, Berghmans, Hermans, and Herregods in 1999 demonstrated that “a small diameter of the bony cervical spinal canal predisposes [a patient] to an adverse clinical outcome after whiplash injury.”

Clearly no two patients are the same. Property damage to a vehicle and forces involved in a Baltimore whiplash injury are not always great predictive indicators of the injury suffered in a whiplash injury. Human metrics, such as the presence or absence of pre-existing conditions, are important indicators when determining the injury severity of a whiplash patient.

If you, or someone you know, has recently suffered from whiplash from a Baltimore car accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Baltimore Whiplash Injury at 2.5 MPH

As a Baltimore chiropractor that spends the majority of my time treating patients involved in whiplash injuries in Baltimore, I see a lot of headaches, neck pain, and back pain associated with Baltimore car accidents. Some of the injuries I see are severe and require referrals outside of my office to other specialists. Some are not so severe and only require a few weeks of treatment in my office for a patient to have complete resolution of their complaints.

One of the most challenging aspects of clinical practice occurs when patients are involved in “minor fender benders” or “no property damage crashes”. That is, the patient’s car is only minimally damaged (just a few scrapes) or not damaged at all. Third party insurance companies that are responsible for paying for injuries caused by their insured are often quick to point out the lack of damage to my patient’s vehicle, and as a result, the near impossibility that my patient could have been injured in any given crash.

In past blog posts I mentioned that there is no scientifically proven correlation between property damage and relative injury likelihood. That is, it is possible to be injured in non-property damage crashes and there is no way to tell just by looking at a bumper whether or not an occupant was injured.

In one research article by Brault, Wheeler, Siegmund, and Brault, in 1998, the authors were able to determine that “analysis of the effect of 4km/h (2.5 mph) impact severity on ROM measurements over time revealed that, at both post-impact examinations, subject with and without symptoms had a significant decrease in cervical flexion, extension, retraction, and right lateral flexion, with left lateral felxion ROM approaching statistical significance.”  It is important to note that many of today’s rear bumpers are built to withstand forces of 2.5 mph and thus do not deform even with enough force to cause injury to an occupant.

As a Baltimore Chiropractor who cares about the musculoskeletal health of his patients, it is often frustrating when injured clients are handled as if they are fakers or malingerers by the insurance companies that they trust to make sure that they get the care they need.  In these instances my patients typically choose to speak to a local personal injury attorney to help fight for their rights to get the care they need while they are under my care for their injuries.

If you, or someone you know, has been injured in a Baltimore car accident and have suffered from whiplash and require treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Often Overlooked Cause of Lower Back Pain Following Baltimore Auto Accidents

When the general public think of me as a Baltimore chiropractor by in large they think of me for two reasons; the first is “back pain doctor” and the second is “the guy you see when you’ve been in a Baltimore auto accident.”

Both of these statements are true and while I like to think that I do more than just treat patients with whiplash, headaches, neck pain, and back pain, these injuries do constitute the majority of the injuries that I see day to day. One of the areas that often gets overlooked as a cause of lower back pain following Baltimore auto accidents are the sacroiliac joints, or SI joints. These are joints that serve to attach the pelvis to the sacrum. As viewed from behind, these are often noted as the “low back dimples” and you can see them on yourself if you look in a mirror. I was trying to find some pictures to post on this blog but the vast majority of them are NSFW (not safe for work).

Rear end automobile crashes of only 15 mph can subject the sacroiliac joints (SI joints) to over 7000 N of force (nearly 1600 pounds of force). Despite being relatively stable joints with a lot of ligaments to hold them in place, there can be enough force with only a moderate impact to sprain these joints or even to tear a ligament entirely. (See page 118 of Dr. Croft’s Book: “Whiplash and Mild Traumatic Injuries, A Guide for Patients and Practitioners”).

Typically speaking these injuries are not that hard to diagnose. Patients who are able to point directly to one or both of their SI joints as a site of pain are usually good at describing the type of discomfort they are experiencing. Where these injuries usually go undiagnosed is in ER or Urgent Care facilities where “nothing is wrong on x-ray” and where the patient is able to ambulate into and out of the facility. A thorough history as well as a proper understanding of the forces resulting from a rear-end auto accident can usually lead the treating provider to an appropriate diagnosis.

In future blog posts I will talk about the other signs and symptoms of SI joint dysfunction as well as the appropriate treatment of such a condition.

In the meantime, if you, or someone you know, has lower back pain from a Baltimore auto accident and you want to get an opinion as to the best way to care for it, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Types of Vertebral Fractures Following Whiplash Injuries

As a Baltimore Chiropractor that spends the majority of my time treating patients with whiplash presenting with headaches, neck pain, and back pain following Baltimore auto accidents (Baltimore car accidents), I spend a lot of time assessing acute injuries, particularly in the neck. One of the tools that I use to grade the severity of an injury is an x-ray. Often patients appear frustrated when I tell them that I need to take x-ray films because they like to say “there’s no way anything is broken.” In some cases, these patients have been to a hospital and a doctor tells them that they don’t need x-rays. While it is true that the vast majority of x-rays do not reveal fractures or dislocations (or any other abnormalities that would otherwise contra-indicate chiropractic spinal manipulation), there are some instances where fractures can be seen on x-ray following a Baltimore auto accident in a patient presenting with whiplash.

The first type of vertebral fracture is called a clay shoveler’s fracture. Usually this occurs at the base of the neck, around C6 or C7. This is a small fracture of the tip of the spinous process when the head “whips” back suddenly and smashes into the vertebrae below it. It was originally named for (as you might have guessed) people who shoveled clay for a living who developed these lesions while working. Needless to say these spinal levels should not undergo chiropractic manipulation, but instead, referred to an orthopedist for treatment recommendations.

The second type of vertebral fracture is called an end plate fracture. These are typically harder to find on an x-ray, and often require other forms of advanced imaging such as MRI to properly diagnose. These type of fracture is important for two reasons. Firstly, the fracture itself can be painful and can be the main cause of a patients neck pain. Secondly, the end plate is a structure that serves to help supply blood and nutrients to the intervertebral discs. Once fractured, the endplate has been shown to decrease its blood supply to a given disc due to scar tissue formation, and thus accelerate the degenerative process of the disc. In addition to pain, these types of injuries cause a vertical height decrease in that spinal level, and the neck as a whole, which can lead to a myriad of problems above and below the level of the lesion.

While it is true that cervical spine fractures are rare following Baltimore auto accidents and are not commonly seen in Baltimore whiplash patients, it is prudent of the health care provider to make sure that it is safe to proceed with treatment prior to beginning therapy. Often hospitals do not see the need to take x-rays, but by not taking films, they miss important diagnoses and patients can suffer longer than needed with undiagnosed neck fractures.

If you, or someone you know, has been injured in a Baltimore auto accident and have neck pain following whiplash, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz