W. Va. Code R. § 85-20-35 - Treatment Guidelines: Cervical Musculoligamentous Injury (Sprain/Strain)

35.1. Symptoms are believed to be related to a partial stretching or tearing of the soft tissues (muscles, fascia, ligaments, facet joint capsule, etc.). Neck pain may be accompanied by vague upper extremity complaints. The recovery period is of variable duration, but generally is less than three or four weeks.

35.2. The appropriate diagnostic criteria consists of the following:

a. Pertinent historical and physical findings documenting the mechanism and degree of force and the time sequence before the onset of symptoms is important. The onset of neck pain and paraspinal muscle spasm begins either suddenly after the injury occurs or develops gradually over the next 24 hours. This pain is usually aggravated by motion of the neck and frequently is relieved by rest. It can be accompanied by paresthesia or a sense of weakness in the upper extremities related to the muscle spasm in the neck. Physical findings include tenderness to palpation, spasm of the paravertebral muscles and aggravation of the pain with motion.

35.3. The appropriate diagnostic tests and examinations are as follows:

a. If indicated by examination, anteroposterior, lateral, lateral flexion and extension x-rays of the spine and open mouth view to visualize the odontoid process are appropriate. Other x-rays may be added to the roentgenographic series as indicated. Straightening of the cervical spine is frequently observed on the lateral x-ray.

b. Further imaging may be indicated depending upon clinical course.

35.4. The appropriate treatment is as follows:

a. Outpatient treatment:

1. Nonoperative treatment:

A. Indications: Almost all injured workers with cervical musculoligamentous (sprain/strain) can be treated conservatively. However, disruption of intervertebral ligaments with subluxation is an indication for surgery.

B. Treatment options:

1. Analgesics;

2. Muscle relaxants;

3. Anti-inflammatory drugs, non-steroidal;

4. Physical modalities and/or rehabilitative procedures may be helpful;

5. Occasional trigger point injections may be helpful; and

6. Manual manipulation and mobilization.

b. Inappropriate treatment:

1. Operative treatment is inappropriate for cervical strain;

2. Narcotic medication for prolonged period of time; and

3. Inpatient treatment.

35.5. The estimated duration of care is 1 to 4 weeks; not to exceed 8 weeks.

35.6. A diagnosis of sprain/strain exceeding this 8 week period requires detailed re-evaluation. The Commission, Insurance Commissioner, private carrier or self-insured employer, whichever is applicable, may require an IME to verify the diagnosis and will authorize continued treatment/coverage in its sole discretion.

35.7. The anticipated outcome:

a. Resumption of normal activity without residual symptoms in most cases.

35.8. Modifiers (age, and co-morbidity). If the injured worker has not responded to the above-outlined treatments within four weeks, the injured worker must be referred to an appropriate specialist.

Notes

W. Va. Code R. § 85-20-35