Shoulder Injuries due to Baltimore Car Accidents

Shoulder Injuries due to Baltimore Car Accidents

As a Baltimore Chiropractor that treats many patients involved in Baltimore car accidents, many people may think that I focus my examination and treatment purely on the spine. I suppose if I were not a Chiropractor I’d think the same thing. But this isn’t true. As a treating provider for these patients it is my obligation to diagnose and treat all musculoskeletal complaints causally related to the car accident, whether they are spinal complaints (neck pain, back pain, headaches) or extra-spinal complaints such as shoulder, elbow, wrist, hand, hip, knee, or ankle injuries. Technically I can also diagnose non-musculoskeletal injuries such as concussions, but that’s a topic for another blog post.

Let’s talk about shoulder injuries. Provided that there is relative motion at the shoulder joint (let’s say a patient is bracing on the steering wheel with one or both hands during an impact, or, say, the seatbelt harness is pinning a shoulder against the driver’s seat during an impact) there can be injuries to the soft tissue of the shoulder. Take a look at this image for an example.

Shoulder Injury Pain and Suffering Award Reduced

Injuries to the shoulder come in many forms. Symptoms from whiplash usually run the gamut from simple sprains and strains to rotator cuff tears, AC joint separations, glenoid labrum tears, or even impingement of the supraspinatus tendon. After a physical examination of the patient I will usually taking plain film radiographs (x-rays) to rule out an obvious issue of fracture or dislocation. Provided that the shoulder is stable I will begin therapy for the shoulder that involves electrical muscle stimulation and/or ultrasound to help with pain and to increase blood flow to the region. Over the course of therapy I will take a patient through range of motion exercises and eventually progress towards stretching and strengthening activities.

Most patients who suffer shoulder injuries as a result of Baltimore auto accidents do well with conservative treatment of these conditions. Some, however, are not so fortunate. Provided that 3-4 weeks of therapy have gone by and a patient is not improving I will usually refer for an MRI of the shoulder. An MRI can take a closer look at the sensitive soft tissue structures of the shoulder and determine if there are any ligament or muscle tears responsible for ongoing discomfort and disability. Once I have a better understanding of the injury I make a determination as to whether continued conservative management is appropriate or if the patient requires referral to an orthopedic surgeon for evaluation of pain and instability.

The shoulder is a complex region. X-rays are, admittedly, limited in their usefulness in many cases following trauma. In the vast majority of cases most patients do well with conservative physical therapy modalities, exercises, and strengthening. For those patients that do not improve, MRI and/or referral to specialists are sometimes appropriate.

If you, or anyone you know, was involved in a Baltimore car accident have suffered a shoulder injury, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Auto Accidents in Baltimore and Washington D.C.

In an attempt to bring the discussion of safe driving to the forefront, AllState recently published its results for the safest (and least safe) cities to drive in the U.S. Once again at the bottom of the list are Baltimore, MD and Washington D.C. AllState ranked the top 200 cities in the U.S. by population and looked at the number of non-fatal auto accidents per capita in a one year period ending in July 2012.

A link to the 2013 report can be found here.

Baltimore ranks number 193 out of 194 safest cities to drive in in the U.S. Drivers in Baltimore are 86.1% more likely to be involved in an auto accident than drivers in the rest of the U.S. Baltimore residents statistically will be involved in an accident every 5.4 years.

The dubious honor of “winner” for least safe roads goes to Washington D.C. with a rank of 194 out of 194. Drivers in Washington D.C. are 109.3% more likely to be involved in a crash than drivers in the rest of the country. D.C. residents are likely to be involved in an accident every 4.8 years.

Hats off to Fort Collins, Colorado who ranks #1 with the least auto accidents per capita this year. Fort Collins residents are 28.1 percent less likely to get in an auto accident as compared to the rest of the country. Fort Collins residents are only expected to be involved in an accident every 13.9 years.

Population density and city planning (old thin roads, lack of major city transportation) has made the Baltimore and Washington Metro areas some of the least safe in the country. With that having been said, it is up to all of us drivers to take proper precaution and not contribute to the problem. Notably, texting and driving is becoming an epidemic, with some reports indicating that it is more likely to lead to teen death behind the wheel than drunk driving.

Be safe out there!

Dr. Gulitz

Low Back Pain: Where Is My Pain Coming From?

Low back pain can emanate from many anatomical locations (as well as a combination of locations), which always makes it interesting when a patient asks, “…doc, where in my back is my pain coming from?”  In context of an office visit, we take an accurate history and perform our physical exam to try to reproduce symptoms to give us clues as to what tissue(s) may be the primary pain generators. In spite of our strong intent to be accurate, did you know, regardless of the doctor type, there is only about a 45% accuracy rate when making a low back pain diagnosis?  This is partially because there are many tissues that can be damaged or injured that are innervated by the same nerve fibers and hence, clinically they look very similar to each other. In order to improve this rather sad statistic, in 1995 the Quebec Task Force published research reporting that accuracy could be improved to over 90% if we utilize a classification approach where low back conditions are divided into 1 of 3 broad categories:

1.    Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2.    Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3.    Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.

The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.

Clearly determining why a patient is having back pain is no easy task. It takes the training and evaluation by a licensed professional such as Dr. Gulitz at Mid-Atlantic Spinal Rehab & Chiropractic to determine which tissues are injured and how to best bring about relief of your condition. If you, or anyone you know, is suffering from back pain in Baltimore please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

This article was reproduced with permission from Dr. Ben Altadonna and “The Practice Building Alliance.”

The Importance of X-rays following Auto Accidents in Baltimore

We’ve all heard stories of people being involved in roll-over auto accidents and being taken away on stretchers to the hospital. When they get to the ER they are given X-rays and/or CT scans to rule out fractures. You may be surprised to realize that in most cases of rear-end auto accidents or in cases where ambulances do not take automobile occupants to the hospital, most ERs/Urgent Care facilities do not take X-rays of the patients.

On one hand, that may seem reasonable. You might think that it is unlikely that these occupants would have suffered fractures. While this may or may not be the case, it is important to recognize that X-rays following auto accidents in Baltimore need to be administered to monitor the stability of spinal segments following trauma, and not just the presence/absence of fractures.

I often joke with patients that I do not have X-ray vision. Following sudden trauma to the spine it is important to rule out not only fractures (which are admittedly rare), but more importantly, any other relative or absolute contraindications to chiropractic therapy. I’ve seen plenty of examples where hospitals/ERs did not X-ray a patient and then when I did in my office I found evidence of ligamentous laxity that would put them at risk of receiving chiropractic manipulation.

Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners”, Dr. Croft notes “…fractures may be missed simply because the ER doctor did not feel the type of injury warranted radiographs. In a report from a group of 32,117 trauma patients here in San Diego, the single most common error identified in missed cases of pathology was failure to obtain an adequate cervical spine radiographic series.” (page 221).

In my nearly 5 years as a practicing Chiropractor in both Las Vegas, Nevada and Baltimore, Maryland I have seen several cases where a patient either did not get an X-ray at the hospital, or was told that they did not need an X-ray. When I insisted we take some films “just to be safe” we discovered subtle fractures and/or aberrant motion that warranted immediate orthopedic referral. Had I not taken the films, I could have put the patient’s health at risk.

In my office not every patient gets an X-ray. My clinical decision making process depends on the patient’s age, presenting symptoms, history, and my physical examination findings. Patients involved in automobile accidents in Baltimore seeking auto accident therapy will always have an X-ray prior to beginning therapy. There’s an old saying in Chiropractic “to see is to know and not to know is to guess…I don’t want to guess about your spinal condition.”

If you, or anyone you know, has been involved in an auto accident in Baltimore and are in need of auto accident treatment in Baltimore, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to take X-rays and render the appropriate course of rehabilitation.

Dr. Gulitz

Cervicogenic Headaches and Neck Pain

Patients with headaches also commonly complain of neck pain.  This relationship is the rule, not the exception. Therefore, treatment for headaches must include treatment of the neck to achieve optimum results.  The term, “cervicogenic headaches” has been an accepted term because of the intimate connection between the neck and head for many years.  There are many anatomical reasons why neck problems result in headaches.  Some of these include:

•    The first 3 nerves exiting the spine in the upper neck go directly into the head.  They penetrate the muscles at the top of the neck near the attachments to the skull and therefore, any excess pressure on these nerves by the muscles or spinal joints will result in irritation and subsequent pain.
•    The origin or nucleus of the 5th cranial nerve called the Trigeminal, innervates the sensation to the face and is located in the upper cervical region near the origin of the 2nd cervical spinal nerve, which innervates sensation to the back of the head up to the top.  Therefore, problems located in the upper neck will often result in pain radiating up from the base of the skull/upper neck over the top of the skull to the eyes and /or face.
•    The 11th cranial nerve that innervates the upper shoulders and muscles in the front of the neck arises from the top 5 to 7 spinal cord levels in the neck.  Injury anywhere in the neck can result in spasm and pain in these large muscle groups.
•    Other interconnections between the 2nd cervical nerve and trigeminal/5th cranial nerve include communication with the 7th cranial / facial nerve, the 9th cranial / glossopharyngeal nerve, and the 10th cranial / vagus nerve.  These connections can affect facial muscle strength/movements, taste, tongue and throat movements, and stomach complaints such as nausea from these three cranial nerve interconnections, respectively.

When patients seek treatment for their headaches, a thorough examination of the neck, upper back, and cranial nerves is routinely performed for the above reasons.  It is common to find upper cervical movement and vertebral alignment problems present in patients complaining of headaches. Tender points located between the shoulder blades, along the upper shoulders, on the sides of the neck and particularly, at the base of the skull are commonly found.  Pain often radiates from the tender point over the top of the skull when pressure is applied in the upper neck/base of the skull area. Tenderness on the sides of the head, in the temples, over the eyes, and near the jaw joint are also common. Traction or pulling the head to stretch the neck is often quite pain relieving and this is often performed as part of the chiropractic visit and can also be applied at home with the use of a home cervical traction unit. Chiropractic adjustments applied to the fixated vertebra in the upper neck often brings very satisfying relief to the headache sufferer.  Exercises that promote movement in the neck, as well as strengthening exercises are also helpful in both reducing headache pain and in preventing occurrences, especially with stress or tension headaches.

As a Chiropractor that routinely treats patients with headaches and neck pain as a result of auto accidents in Baltimore, I see patients with headaches and neck pain every day. If you, or someone you know, can use the help of a Baltimore Chiropractor for headaches and neck pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

The above information was reproduced with permission from Dr. Ben Altadonna and “The Practice Building Alliance”.