This case study is about a 19-year-old girl who first presented to our clinic with neck and left shoulder pain after she was involved in a motor vehicle accident.
Mechanism of Injury / History of Presenting Symptoms:
She was the third car in a four-car pile-up and she reports her head was flung forwards and back quickly and her sunglasses flew off at the time. Initially, she was in so much shock she doesn’t remember feeling any pain. It wasn’t until she got home that afternoon that she noticed her neck had ceased up and her pain levels gradually increased to the point she was almost unable to move her neck or lift her left arm. Her major concern at this time was what had occurred structurally in her neck and whether she had broken a bone or was going to have long term deficits because of the injury.
Her short-term goals involved reducing her pain and regaining her movement in her neck and shoulder. Longer term, she wanted to be able to drive again without fear and return to work at a where she was required her to spend time sitting, standing, looking down, lifting, bending and twisting.
After a thorough assessment of her neck and shoulder we were confident she didn’t have a fracture in her spine however to be sure I referred her to her GP for a second opinion and to give her advice around any pharmaceutical options she had to help her sleep and to decrease the pain she was experiencing in the short term. Upon deliberation with her GP she didn’t end up needing a scan and was able to take pain relief and anti-inflammatory medications as needed for the first few weeks post injury. In terms of physiotherapy we started with gentle massage and mobilising techniques and gave her gentle movements and stretches to begin her neck and shoulder rehabilitation. Given the extent of her movement restriction and the weakness in her shoulder we knew we would be seeing her for rehabilitation over a few months.
She has now gone through three months of physiotherapy rehabilitation and I reviewed with her yesterday. Currently she has full range of movement in her neck and left shoulder and doesn’t feel limited in her capacity to use her left arm for day to day activities. She has returned to driving and feels safe and confident behind the wheel. We contacted her workplace and discussed with them modified duties she was able to start approximately four weeks post injury. We gave her workplace weekly updates on her progress and increased her duties gradually until she resumed full duties approximately three weeks ago. Her only remaining deficits are her strength tests on her left shoulder. Her left shoulder testing reveals she has returned to approximately 80% of the strength of her right side. She is currently performing a progressive home strengthening program which we will continue to update approximal once a month aiming to regain her full strength in order to prevent injury in the future to her shoulder.
Her road to recovery was challenging as she experienced many ups and downs in her pain levels as she began returning to activities. Some weeks she felt she had made little progress and other weeks she made large improvements. A lot of her rehabilitation involved educating her to listen to her body and pace herself throughout the day so she didn’t experience the boom/bust cycle we see so many patients go through. This is where patients begin feeling better and then think they can do all of the things they did pre-injury. This results in them then “busting” or aggravating their injury/symptoms. She stated the biggest lessons she learnt from her injury was the importance of listening to her body and persisting with physiotherapy rehab even when you feel like you may be having a bad day.