Ortho
5/28/99

Whiplash
•	upper extremity injury
•	lower extremity—knees, seat belt doesn't lock and knees hit the dash
•	thyroid injury (esp. vasculature going to the thyroid)—clinical hypothyroidism—check thyroid function shortly after accident (TSH)
•	cranial nerve exam
•	fundascopic exam
•	tempromandibular joint
•	mild brain trauma—post concussive syndrome
•	one potential result of the cervical acceleration/deceleration syndrome (CAD)
•	aka:  Mild Traumatic Brain Injury (MTBI)
•	brain injury which leaves the pt temporarily or permanently impaired in everyday pursiuts
•	alteration in mental state or loss of consciousness is criteria (not a requirement)
•	40-60 % of those w/MTBI may have posttraumatic headaches; associated symptoms include:	headache
irritability
insomnia
anxiety
memory problems
other pain
concentration problems
depression
confusion
loss of emotional control
loss of libido
tinnitus
cannot carry out plans 
cannot plan 
flashbacks
arithmetic problems (logical solving)
•	brain loss is permanent
•	PET—positron emission tomography—functional patterns in the brain (reaction can be measured)

Thoracic Outlet Syndrome
•	neurologic and/or vasculature prolbem
•	common sites of compression
1.	 interscalene compression—subclavian aretery and/or brachial plexus
2.	costoclavicular—1st rib and the clavicle; subclavian/axillary artery and brachial plexus—anytime a shoulder problem, need to check the clavicle
3.	pec minor-coracoid—hyperabduction of the arm
4.	cervical rib—pt either has or not
•	Adson's Test—doc evaluate radial pulse as pt changes position (vascular component) (decrease in pulse amplitude)
•	costoclavicular maneuver—palpate pulse bilaterally, chin to chest, shoulders back, clavicle come down to 1st rib
•	wright's test—palpate radial pulse, bring arm up in abduction
•	halstead maneuver—palpate radial pulse, hyperextend neck (w/cervical rib (+))
•	traction test—
•	roos' test (A.E.R)—flex and extend fingers for a min of 3min.