A 32 year old lady was seen in the Pain Clinic, who had suffered a road traffic accident approximately 7 months prior to coming to the Pain Clinic. She suffered a whiplash injury where her head had undergone acceleration/deceleration injury. This lady had been treated for whiplash initially with a soft collar and then had had multiple analgesic medications prescribed to her. Although this had some benefit, it never got rid of all the pain. She also had regular physiotherapy once a week but despite all of these conservative measures, she still had persistent neck pain.
Clinical examination of patient with whiplash injury
When she was reviewed in the Pain Clinic, her neck was examined and it was noticed that a number of her cervical facet joints were tender on deep palpation, and she had slightly reduced flexion but markedly reduced extension of the neck and tenderness of these facet joints on palpation. She also had global reduction in the range of lateral movement of the neck. Also on palpation, she was found to have a number of trigger points, particularly in the shoulders, neck and back, which corresponded with small, taught bands of muscle, and associated with secondary myofacial pain syndrome (secondary fibromyalgia).
Technique of X-ray guided cervical facet joint injections
This lady was keen to find a more aggressive approach to her neck pain. She was therefore booked in for x ray guided cervical facet joint injections. These were performed bilaterally from C4-T1 and also injections into the trigger points with local anaesthetic and anti-inflammatory were done. A total of 80 mg of Depo-Medrone and 20 mls of 0.25% Bupivacaine were used during the procedure.
Post procedure outcome
Post procedure, at about 10 days, he was reassessed by a physiotherapist and given a number of gentle neck exercises along with exercises to improve her core stability. She was followed up approximately 4 months later in the Pain Clinic. Her symptoms had almost completely resolved. She got the odd twinge from her neck and when this occurred, she would take as required non steroidals, but was otherwise not requiring a collar and was back to functioning normally. She was then discharged from the Pain Clinic.