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Chronic pinch/catch

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Hey gang,

I have a 44-yo male patient, roll-over MVA in Sept 07. We began tx in October. Pain level virtually gone except...he still gets a sharp pinch/catch, left C/Th with certain movements!

I can reproduce this with manual traction of the neck in the supine position, and when I let-go (fairly quickly)...he just jumps and squirms with sharp/pinching pain. He's focally tender over the C7 and T1 sp's on the left... X-rays negative for fx, MRI negative for disc/stenosis...

This condition acts like a meniscal-block and/or facet pinch...but, it's not getting better, and as we've decreased tx, it's actually gotten worse. Any thots on how to DDX this beast (i.e., motion studies, etc) so that I can communicate it's existence to the insurance company???

Thanks in advance for your input.

M. s, D.C.

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