| Date | Event | Source |
|---|---|---|
| 2022-03-15 | Restrained driver, stopped at red light, struck from behind at approximately 40 km/h. Complains of immediate neck and interscapular pain. No loss of consciousness. Transported to emergency department. | ED triage note |
| 2022-03-17 | Assessment at walk-in clinic for ongoing neck and upper back pain. No radicular symptoms. Cervical range of motion limited by pain. Neurologic exam grossly intact. | walk-in clinic note |
| 2022-03-22 | Initial physiotherapy assessment. Findings include cervical paraspinal muscle spasm, restricted rotation/lateral flexion. Treatment plan: postural re-education, manual therapy, graduated exercises. | physiotherapy initial assessment |
| 2022-04-27 | Follow-up with family physician. Reports new right-arm radicular pain radiating to thumb and index finger, with intermittent tingling. Positive Spurling test on right. Prescribed nabumetone and referred for MRI. | family medicine progress note |
| 2022-05-01 | Gabapentin 300 mg at bedtime initiated for neuropathic pain. | prescription record |
| 2022-06-14 | MRI cervical spine: C5-C6 disc protrusion with asymmetric right posterolateral component causing moderate right foraminal narrowing and impingement of the exiting C6 nerve root. Multilevel spondylosis and mild diffuse disc bulging without cord compression. | MRI report |
| 2022-07-12 | Neurosurgery consultation. Neurologic exam confirms diminished right biceps reflex and hypesthesia in C6 dermatome. Recommends continued conservative management with physiotherapy and neuropathic pain agents; surgical intervention not immediately indicated. | specialist consult note |
| 2022-09-20 | Nerve conduction study/EMG: evidence of acute-on-chronic right C6 radiculopathy with ongoing denervation. No peripheral nerve entrapment. | electrodiagnostic report |
| 2022-11-08 | Physiatry re-evaluation. Persistent right-sided neck pain with radicular symptoms into forearm and thumb/index. Limited tolerance for prolonged sitting or overhead activities. Advised to continue gabapentin, physiotherapy, and consider transforaminal epidural steroid injection. | physiatry note |
| 2023-02-14 | Family physician follow-up. Pain intensity reduced by approximately 40% with combined treatment but continues to impair work tasks and sleep. No new neurologic deficits. Plan to wean gabapentin if tolerated and maintain active rehabilitation. | family medicine progress note |
The C5-C6 disc herniation and resulting right C6 radiculopathy are causally related to the March 15, 2022 motor-vehicle collision, superimposed on pre-existing but previously asymptomatic degenerative changes.
The temporal sequence strongly supports a causal relationship. Ms. M. had no prior neck or arm pain requiring medical attention, and she was fully functional until the rear-end collision. Same-day axial pain, followed six weeks later by typical C6 radicular symptoms, and an MRI demonstrating acute disc protrusion with foraminal narrowing at the corresponding level, is a classic post-traumatic pattern. While the MRI also shows multilevel spondylosis, such degenerative findings are common in asymptomatic individuals in their fourth decade and do not diminish the role of the collision in precipitating the symptomatic disc herniation. The forces involved—a 40 km/h rear impact on a stationary vehicle—are sufficient to cause acute discogenic injury, particularly in the cervical spine due to whiplash-type acceleration-deceleration. No competing explanation (e.g., lifting accident, sports injury) appears in the records.
The care provided—early physiotherapy, NSAIDs, neuropathic pain medication, appropriate imaging, and surgical referral—is reasonable and consistent with standard practice. The presence of pre-existing spondylosis may prolong recovery but does not represent an alternative cause; rather, it made the cervical spine more vulnerable to acute injury. Causation opinion rests on the clear biomechanical plausibility, temporal proximity, and lack of prior symptomatology.
Prognosis is guarded. While many post-traumatic radiculopathies improve over 12–18 months with conservative management, the combination of foraminal stenosis and superimposed disc injury suggests that some degree of chronic neck pain and intermittent radicular symptoms is more likely than complete resolution. The EMG evidence of ongoing denervation indicates axonal involvement, which typically heals slowly and incompletely. She has shown partial improvement at one year, but sustained intensive computer work or manual tasks will likely provoke symptoms.
She will require ongoing active rehabilitation with a focus on cervical neuromuscular control, ergonomic modifications for sedentary work, and possibly further interventional pain procedures such as a transforaminal epidural steroid injection if radicular pain flares. Periodic specialist reassessment (physiatry or neurosurgery) is warranted. Should symptoms progress, a foraminotomy or disc replacement might be considered in the future, though current management is non-operative. Medications may be needed on an as-needed basis. Vocational counseling regarding modified duties would be beneficial.