Case Study: Neck Pain following a fall


A 45 year-old male reports to physical therapy with c/o of unilateral neck pain.  Pt states that he fell from a ladder four days ago and now has pain when he tries to look over his left shoulder.  He states that his symptoms are on the right side of his neck, which feels sharp (4/10) and moves up over his head to behind his eye as the day progresses (9/10).  He is unable to find relief once the headache starts and has to lie down for a 1-2 hours until the pain decreases to a level that is somewhat tolerable (6/10).  He reports that he has had a headache at the end of each day since the accident (6/10).  His neck pain has interfered with his ability to drive and work since he is unable to check his blind spot in the car and move and talk to his colleagues with out an increase in pain and a headache. Pt states that he would like to have his neck “cracked” because that has helped with his neck pain in the past.

Welcome to your Neck Pain

What parts of the subjective exam needs further questioning?
What is this patient’s irritability level?
What is his severity level?
How vigorous do you plan to be during the physical exam?
What areas of the body need to be ruled out in the physical exam? If so, what is your approach to ruling this area out? 
What are some red flags that need to be ruled out before you begin treatment?
What areas or diagnosis need to be ruled in through the physical exam? If so, what is your approach in ruling this area in?
Do you plan on doing a neurological exam?  If so, why and what are the elements of that exam?
What are two Functional Asterisk Signs for this patient?

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