Dr. Mollins, Brooklyn’s premier accident doctor, always performs orthopedic testing when conducting a physical examination. Orthopedic testing is an essential part of the physical examination. When Dr. Mollins evaluates an individual involved in an accident (automobile, work, construction, or slip and fall), he initially takes a concise history which includes the mechanism of the accident (specifically how the accident occurred) and if there were any pre-existing conditions (i.e. a previous accident). The next step is to perform a comprehensive physical examination. Orthopedic tests enable Dr. Mollins to attain a concise diagnosis. These tests are performed by placing the patient into specific positions. Pain or inability to perform specific movement is considered to be a positive sign. A positive sign is indicative of the particular diagnosis that the orthopedic test is testing for.
When evaluating injuries to the cervical spine sustained by patients involved in accidents, orthopedic testing is crucial in making a differential diagnosis. Neck pain (resulting from an accident) can be due to a disc injury which can pinch a nerve causing radicular pain (pain in the neck and/or pain radiating into the arm) or simply a sprain/strain (a muscular and/or ligamentous injury). Both of these conditions may have similar symptomatology, but must be differentially diagnosed because a disc injury (causing radicular pain) may be a serious condition requiring extensive treatment yet a sprain/strain is usually much less dire.
The following is a list of orthopedic tests for the cervical spine that are regularly performed by Dr. Mollins when evaluating patients injured in accident:
- Foraminal Compression Test – The patient is seated on the examination table. Dr. Mollins will gently, but firmly, place his hands on the patients head and press down applying pressure to the top of the head. This will cause “compression” to the cervical spine. If the patient feels pain in the neck and/or down the arm we have a positive test. A positive test is indicative of disc injury possibly causing radiculopathy.
- Valsalva Sign – The patient is seated. The patient is asked by Dr. Mollins to take a deep breath, hold, and bear down. If the patient feels pain in the cervical spine and/or down the arm we have a positive test. Again, a positive test is strongly indicative of a disc injury.
- Linder’s Test – The patient is supine (lying on their back). Dr. Mollins will then place his hand under the patients head and flex the patient’s neck (bring the patients head up, attempting to bring the chin to the chest). If the patient is unable to do this due to neck pain or performs the full test and feels neck pain, we have a positive. A positive is indicative of a disc problem.
- Soto Hall – This test is similar to Linder’s Test. The patient is lying supine (on their back) while Dr. Mollins flexes the patient’s neck with one hand while supporting the patient’s sternum with the other. If the patient feels pain during the test, once again, we have a positive. A positive Soto Hall is indicative of a disc injury.
Other than orthopedic tests, a comprehensive physical examination also consists of careful observation of the patient (i.e. does the patient have any visible scars or bruises, is the patient walking with an antalgic gait, also does the patient have difficulty getting on and off the examination table), palpation, reflexes, range of motion testing, sensation, and measurement of muscles to determine atrophy. However, orthopedic testing still remains a vital part of the physical examination.
Once a concise accurate diagnosis is determined, Dr. Mollins will then place his patient on a comprehensive treatment regimen so that his patients may achieve wellness as expeditiously as possible.