Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Pain varies from person to person and is hard to measure. The doctor will rely on your description of your symptoms to better quantify your pain. You may be asked to rate your pain on a scale from
one to 10 with 10 as the worst pain. Although difficult to generalize, the following types of symptoms usually predict the types of anatomic structures injured:
Cramping, dull, aching pain may indicate that muscles may be injured.
Sharp, shooting pain could be injury to a nerve root.
Sharp, lightning-like pain may indicate that a nerve is injured.
Burning, stinging pressure may indicate nerve injury.
Deep, nagging, dull pain could be injury to a bone.
Sharp, intolerable, severe pain could indicate a fracture.
Throbbing, diffuse pain may be injury to blood vessels.
As well as trying to determine the severity of your pain, the doctor will focus on several other key areas:
How you were injured
Your type and usual level of activities
The presence (or absence) of head impact and loss of consciousness
The way your symptoms developed
Factors that make you feel better or worse
Radiation of the symptoms away from the neck and the
presence of any symptoms that suggest nerve problems such as weakness, altered
sensation, tingling, and (particularly ominous) any bowel or bladder
Physical evaluation for neck strain may be divided into the phases of observation, touching your muscles and other structures in your neck (palpation), examination of the blood vessels in your neck, nerve testing and, finally, an assessment of your ability to move. In most cases of trauma involving a significant mechanism of action, a complete examination is usually not completed until a set of preliminary X-rays has confirmed the lack of fractures (broken bones) and dislocations of the cervical spine.
The doctor may wish to see you walk into the examination room and may also observe
for any difficulty undressing yourself.
Typically, your posture, gait, facial expression, willingness to move for examination, and ease of movement will be assessed.
The doctor will be interested to see whether your
head is rotated to one side. This usually indicates muscle spasm of the neck (called torticollis).
The position of your chin and head will be noted as well as your habitual posture and the symmetry of the neck contour formed by the trapezius muscle.
The posture of your head and neck may also be checked while you sit and then stand. Any differences will be noted.
Your shoulders will be checked to see if they are level when you are relaxed. Asymmetry often indicates muscle spasm.
Doctor observation is often also sufficient to lead to a suspicion of a problem causing an inadequate blood supply (ischemia) in one of
the upper limbs. Your doctor will examine the blood vessels in your neck by
feeling the pulses to assess for briskness of upstroke and fullness, and the
presence of any abnormal sounds heard with a stethoscope placed over the blood
vessel (auscultation). The doctor will also look for any evidence of any
increased pressure in the neck veins (distended or bulging jugular veins). The
doctor will check your trachea, particularly if you have any symptoms of hoarseness.
The doctor will also palpate your head, neck,
shoulders, and possibly other areas. Palpation is useful in detecting
differences in tissue tension, texture, and thickness, tenderness, and abnormal sensation. In addition, differences in temperature and dryness (or excessive moisture) become readily apparent. Tremor (shaking) and muscle twitches may also be checked in this manner.
The doctor will perform neuromuscular testing to determine whether you have any injuries to the nerves and joints in your neck. These tests typically involve moving your body both passively and actively, to assess for strength, range of motion, and any loss of sensation.
The combination of a detailed history, physical examination, and one or more imaging procedures should enable your doctor to exclude, or identify, any serious injury to your neck and thereby plan your treatment.