Bilateral symptoms must always trigger the question; why are the symptoms bilateral? Neurological testing must be rigorous with patients who comment on bilateral symptoms.  DT Reflexes, long track reflexes, myotome and dermatome systems must be evaluated as multilevel results are worrisome.  Bilateral may mean central causes.

McCartney, S., Blagg, S., Baskerville, R., & McCartney, D. (2018). Cervical radiculopathy and cervical myelopathy: Diagnosis and management in primary care. British Journal of General Practice, 68(666), 44–46. https://doi.org/10.3399/bjgp17X694361

She received four Physical Therapy sessions within the first four weeks of the accident.

On examination at the first PT session, she had full ROM of her cervical spine (with the exception of extension as she has DDD of the cervical spine) without pain. On neurological testing, she had mild hyperreflexia and no weaknesses were noted.  She did have multiple vague dermatome changes in both upper extremities.  The patient received four PT treatments over the next few weeks with minimal improvement.  Treatment consisted of manual therapy for rib rings 2, 3, 4, manual distraction of the Cervical spine, static home Saunders traction and iontophoresis.   The manual distraction and home traction increased symptoms and the rib ring releases improved the symptoms, temporarily.  The iontophoresis utilizing dexamethasone provided temporary relief.

Within four weeks of the accident, the numbness had not resolved and she was presenting with weakness in both hands specifically the thenar, opponens pollicus and intrinsic muscles.  During the period of time from the accident, she did not experienced neck pain or headaches.  She returned to her Physician and was prescribed a dose pack of 7 days of steroid treatment.  This provided significant improvement for two weeks.  Two weeks later the patient began experiencing frequency of urination, difficulty swallowing and the numbness of both arms and weakness of both hands had returned. She was also starting to note an inability to abduct the toes on her left foot.   She was referred to a neurosurgeon and a urologist.

Question:  Do you think the symptoms of bladder frequency and urgency are of any importance considering the age of the patient?