Morbid obesity

The patient is a 52-year-old female, who works as a credit collector. On March 31, 2012, she was the driver of a vehicle that was stopped in traffic waiting for another vehicle to move. She was rear-ended by another car and causing her car to suffer severe damage. She was taken to the local hospital, where she was treated and released. After the accident, she started experiencing severe pain in her upper thoracic and neck area. She was treated by an orthopedic surgeon in a conservative manner and in May, she was referred to the chiropractor who started treating her until the present time. Her pain has improved, but is still bothering her to the point that it is interfering with her activities of daily living and enjoyment of life. At this point, it appears that she has reached a plateau with her chiropractic treatment and has been not getting any better. She described her neck pain as follows: Duration: Constant. Quality and intensity: 5/10. Radiation: Posterior neck and upper thoracic area radiating to the shoulders. She also complains of sensation of numbness in both hands. Aggravating factors: Rotation, extension and flexion of the neck. Alleviating factors: Nothing. Description of the pain: Achiness, numbness, and stabbing pain.

DIAGNOSES:
1. Cervicalgia.
2. Cervical herniated disc.
3. Cervical radicular pain.
4. Morbid obesity.

RECOMMENDATIONS:
1. We will obtain EMG of both lower extremities in order to evaluate the nature of her pain. The EMG/nerve conduction study will allow me to assess whether this pain has a radicular component due to the herniated discs that are present versus muscular pain versus carpal tunnel syndrome.
2. She was encouraged to continue the use of anti-inflammatories in order to have her control the pain.
3. Follow up in four weeks.
4. I discussed with the patient the possible performance of cervical epidural steroid injection versus cervical medial nerve block. It will depend on the EMG/nerve conduction studies results the next step in the treatment plan.

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