Clinicians frequently provide treatment to clients that have experienced a non-traumatic spinal cord injury. As Healthcare professionals understanding common, non-traumatic causes of myelopathy including inflammatory diseases, infections, vascular diseases, toxic-metabolic disorders, inherited-degenerative conditions, and neoplasms will positively affect the ability to proficiently assess, prepare a plan of care, implement the plan and evaluate its outcomes and explain deficits to other healthcare professionals. The below scenario demonstrates how increased awareness of non-traumatic spinal cord injury can improve outcomes for clients.
A 60-year-old female client is referred from an Urgent Care Center, Workman’s Compensation physician, for Outpatient Occupational Therapy to evaluate and treat the client with right shoulder pain, secondary to work-related upper extremity strain.
During the initial evaluation, the client indicates that she works for a local airline. She is the manager of the baggage claim department, specifically the area where lost baggage is stored until the owner is located and comes in for a pickup. She has been a manager for five years but has worked in the same department for 10 years. On this particular day, she was filling in for another agent, when she needed to place a small boarding bag on a top shelf. The client reports that when she raised the bag up over her head, she felt “electrical shock like” sensations down her back. Further investigation reveals that she experienced this same sensation about two weeks ago when washing her hair. Client states that she feels that her right arm is getting weak and impacting her ability to fasten a bra, wash her hair, as well as her ability to function optimally at her job.
Physical exam included ROM of both UE’s, which is WNLs. Strength assessment of BUE’s that indicates clients:
- Strength in the RUE is 3+/5 as compared to the LUE which is 5/5.
- Grasp strength assessment results are R-an average of 28#s, L-an average of 44# Norms are R 55#s L 45#s.
- Arm Curl Test scores are R 12 reps in 30 secs with 5# dumbbell, and L 15 reps Norms are 13-19 reps in 30 secs with 5# dumbbell.
Each of these assessments indicates the client has a significant loss of strength in the RUE.
Sensory exam indicated the client presents with:
- Numbness of the middle and index finger,
- Observable atrophy in the intrinsic muscles of the hand and
- Impaired pain and temperature sensation in the middle and index fingers.
Each of these assessments indicates the client has impaired motor and sensory function along the C 6-7 myotome/dermatome.
The client is scheduled for Occupational Therapy, 3x a week x 2 weeks. The treatment plan includes Therapeutic Ex-strengthening program. Self-Care Training-use of compensatory strategies to don/doff bra and wash hair and patient education. Therapeutic Activities- including functional task practice and task modification.
The above evaluation is faxed to the MD, with a follow-up phone call. During the phone call, the OT expressed concerns and advised the MD of findings of the exam with emphasis on the assessment results that are inconsistent with a strain, including; complaints of shock like sensations when extending head (+ Lhermitte’s sign), strength loss of RUE, and loss of sensation along the C6-7 myotome/dermatome.
The OT suspects the client has been misdiagnosed or presents with multiple diagnoses. Following the MD’s review, it is determined that the client has a probable cervical spondylosis, a form of central cord syndrome, as well as a shoulder strain.