title: Clinical decision making associated with an undetected odontoid fracture in an older individual referred to physical therapy for the treatment of neck pain.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  The purpose of this paper is to provide the examination of and decision-making process for a patient referred to physical therapy for the treatment of neck pain following trauma. She was found to have an underlying odontoid fracture that precluded physical therapy intervention.
  
  
  METHODS
  This case involved a 73-year-old woman who had a sudden onset of neck and left upper extremity pain after a fall 15 days prior to her initial physical therapy visit. Conventional cervical spine radiographs completed 1 day prior to her initial physical therapy visit were negative for a fracture. However, several components of this patient's history and physical examination were consistent with a condition for which physical therapy intervention would not be indicated until more definitive cervical spine diagnostic imaging had been completed; more specifically, the physical therapist was primarily concerned about the possibility of an undetected fracture. The referring physician was contacted and immediate magnetic resonance imaging was requested, which revealed a type II fracture of the odontoid. Thirty-four days after her fall, the patient underwent a C1-C2 fusion.
  
  
  CONCLUSIONS
  When evaluating patients with neck pain who have a history of cervical spine trauma, it is important that physical therapists understand the clinical findings associated with cervical spine fractures, as these findings provide guidance for the use of cervical spine diagnostic imaging and medical referral prior to implementing physical therapy interventions.
  
  
  METHODS
  Diagnosis, level 4.
authors.affiliation: Department of Physical Therapy, David Grant US Air Force Medical Center, Travis Air Force Base, CA 94535, USA. michael.ross2@travis.af.mil
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ross
authors.forename: John M
authors.initials: JM
authors.lastname: Cheeks
mesh_terms: D000368:Aged; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D009809:Odontoid Process / Q000293:injuries*; D026741:Physical Therapy Modalities; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000628:therapy*