Q: 63 years old female with a BMI of 42 and a history of motor vehicle trauma, is now extubated after an episode of community-acquired pneumonia. Since extubation, she is complaining of right-sided neck and arm pain. Patient also required 'prone position' during her intubation. Cervical radiculopathy is suspected due to physical stress incurred while receiving pronation. Bedside clinical exam with Right shoulder abduction tends to make pain? (select one)
A) better
B) worse
Answer: A
There are three objectives of this question.
First, performing a prone position requires a trained team/staff. Patients can endure various physical trauma which can have long-lasting effects.
Second, a bedside clinical exam is essential as well as the most effective way of diagnosing various diseases.
Third, to provide simple conceptual knowledge that shoulder abduction at the same side where cervical radiculopathy is suspected, not only helps diagnose the pathology but also provides relief from the pain. Shoulder abduction test on the same side of cervical pain has a very high specificity for diagnosing cervical radiculopathy.
#physical-exam
#pulmonary
#musculo-skeletal
#neurology
References:
1. Rubinstein SM, Pool JJ, van Tulder MW, et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 2007; 16:307.
2. Offner PJ, Haenel JB, Moore EE, Biffl WL, Franciose RJ, Burch JM. Complications of prone ventilation in patients with multisystem trauma with fulminant acute respiratory distress syndrome. J Trauma. 2000 Feb;48(2):224-8. doi: 10.1097/00005373-200002000-00004. PMID: 10697078.
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