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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 147-148

An unusual cause of neck pain in the physiotherapy clinic: Neglected clay-shoveler's fracture


Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission03-Jun-2020
Date of Decision04-Jun-2020
Date of Acceptance03-Jul-2020
Date of Web Publication04-Jan-2021

Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_12_20

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How to cite this article:
Dharmshaktu GS. An unusual cause of neck pain in the physiotherapy clinic: Neglected clay-shoveler's fracture. Indian J Phys Ther Res 2020;2:147-8

How to cite this URL:
Dharmshaktu GS. An unusual cause of neck pain in the physiotherapy clinic: Neglected clay-shoveler's fracture. Indian J Phys Ther Res [serial online] 2020 [cited 2021 Jul 27];2:147-8. Available from: https://www.ijptr.org/text.asp?2020/2/2/147/189937



Neck pain is a common presentation leading to varied disabilities be it acute or chronic one. Mostly, the pain is mechanical and commonly associated with abnormal loading incidents, such as bad posture, heavy weight, repetitive, or minor injuries. Rarely, sinister causes such as neuroanatomical anomalies, neoplastic lesions, or major fractures may be found and demand appropriate multidisciplinary management. Chronic pain cases undergoing physiotherapy sessions with off and on recurrence of pain may require additional investigations.

A 48-year-old male patient, laborer by profession, presented to us with chronic neck pain for the last 2 months. There was neither history of significant trauma nor any history of chronic diseases. There was mild tenderness over posterior neck, but neurological status was intact. Only extreme neck movements were painful. As his job required frequent heavy weight lifting on head, provisional diagnosis of mechanical musculoskeletal pain was made, and supervised physiotherapy was advised along with pain medications for few days. He underwent dedicated physiotherapy for 10 days with only mild relief that was again followed by pain. He was advised magnetic resonance imaging (MRI) to exclude disc-related problem. The MRI revealed normal vertebral and disc components. There was edema over posterior spinal elements with cortical discontinuity noted in spinous process of the cervical C5–7 vertebrae [Figure 1]a, [Figure 1]b, [Figure 1]c. The axial view showed still persistent edema over posterior spinous process [Figure 1]d. The patient was finally diagnosed as case of neglected mildly symptomatic Clay-Shoveler's fracture without neurological involvement. The patient did not have pain and disability corresponding to the injury and may be related to repetitive stress leading to avulsion and higher pain threshold of the heavy manual laborer. The patient was advised rest to the neck with soft collar for 2 weeks before another session of cervical muscle strengthening isometric exercises and fomentations with short-wave diathermy. He noted gradual improvement in pain and disability over the next 6 weeks of supervised sessions.
Figure 1: Magnetic resonance imaging showing sagittal T2-weighted view showing normal spine alignment without any disc-related problem or neural compromise except cortical break in C5–7 spinous processes with little edema (a). The sagittal T1-weighted images also confirm and delineate the fractures (b and c). The axial views, at corresponding levels of affected spinal area, showing edema and fracture of contiguous spinous processes (d)

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Clay-Shoveler's fracture is oblique stable fracture through spinous process of the lower cervical vertebrae, mostly C6 or C7, and commonly results from road traffic accidents.[1] It is also considered as a stress-type avulsion fracture of the lower cervical and upper dorsal spinous processes. The injury, historically related to clay-shovelers of the past, is now usually found in sportspersons and requires a course of rest, analgesia followed by mobilization as per tolerance as standard treatment.[2] Isolated dorsal spine involvement with bilateral radiculopathy is also reported.[3] Stress avulsion of spinous process following hyperflexion sport-related activities is also reported but limited to few reports. Stress avulsion through trapezius and rhomboid is seen in these cases.[4] Rarely, multilevel fractures are noted but managed conservatively in most cases.[5] In this case, the injury might have resulted from repetitive stress and resultant avulsion injury, which was not very disabling leading to neglect. This uncommon injury has potential to be overlooked and neglected by patient and doctors alike.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Toman E, Beaven A, Harland S, Porter K. Clay-Shoveler's fracture: A snapshot. Trauma 2016;18:186-9.  Back to cited text no. 1
    
2.
Posthuma de Boer J, van Wulfften Palthe AF, Stadhouder A, Bloemers FW. The Clay Shoveler's fracture: A case report and review of the literature. J Emerg Med 2016;51:292-7.  Back to cited text no. 2
    
3.
Kang DH, Lee SH. Multiple spinous process fractures of the thoracic vertebrae (Clay-Shoveler's fracture) in a beginning Golfer: A case report. Spine (Phila Pa 1976) 2009;34:E534-7.  Back to cited text no. 3
    
4.
Hwang IY, Park SJ, Cha JR. Clay-Shoveler's fracture in an 18-year-old cheerleader: A case report. J Korean Fract Soc 2018;31:57-60.  Back to cited text no. 4
    
5.
Akhaddar A, El-asri A, Boucetta M. Multiple isolated thoracic spinous process fractures (Clay-Shoveler's fracture). Spine J 2011;11:458-9.  Back to cited text no. 5
    


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