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South College MSK 3 > Week 3: Neck Pain Screening for Risk & Harm > Flashcards

Week 3: Neck Pain Screening for Risk & Harm Flashcards

1
Q

Cervical arteries

A
  • Carotid

- Vertebral

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2
Q

How might cervical arteries get injured?

A
  • Age related

- Traumatic, causing occlusion

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3
Q

What is the predominant symptoms of a stroke?

A

Pain in the neck

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4
Q

Which type of stroke should we be most aware of?

A

Vertebral artery, less common than those of the carotid artery

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5
Q

Reasons to suspect causation of a stroke by manipulation

A
  • Can happen, but very rare
  • If there is an increase of pain after the manipulation
  • As the time b/t manipulation and stroke gets smaller, there’s greater reason to assume causality
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6
Q

Average risk level of adverse events after cervical manipulation

A

1 in ~ 2 million

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7
Q

Incidence of vertebral artery dissection causing stroke

A

0.97 per 100,000

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8
Q

Incidence of all strokes

A

269 per 100,000

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9
Q

Reasoned estimate of risk from chiropractic manipulation and stroke

A

1.3 per 100,000

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10
Q

There is an association b/t vertebrobasilar stroke and chiropractic visits in what age group?

A

<45 years old, but there is also a similar association b/t vertebrobasilar stroke and primary care physician visits in all age groups

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11
Q

What is a likely explanation for risk of vertebrobasilar stroke associated w/ visits to medical professionals?

A

There is dissection-related neck pain and headache prior to the visit

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12
Q

PTs routinely use cervical manipulation with patients who have:

A
  • Neck pain
  • Headache
  • Dizziness
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13
Q

Risk for intervention: Cervical spine manipulation (low estimate)

A
  • 0.005/10,000

- Potential complication: paralysis, stroke, death

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14
Q

Risk for intervention: Cervical spine manipulation (high estimate)

A
  • 0.9/10,000

- Potential complication: paralysis, stroke, death

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15
Q

Risk for intervention: vigorous exercise

A
  • 0.002/10,000

- Potential complication: Sudden death

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16
Q

Risk for intervention: NSAIDS

A
  • 100-300/10,000

- Potential complication: GI bleed

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17
Q

Risk for intervention: NSAIDS w/ developed bleed

A
  • 20/10,000

- Potential complication: Death

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18
Q

Nonischemic (local) symptoms of vertebral artery dissection

A
  • Ipsilateral posterior neck pain/occipital headache
  • C2-C6 cervical root impairment (rare)
  • May precede cerebral/retinal ischemia by a few days-weeks
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19
Q

Ischemic symptoms of vertebral artery dissection

A
  • Hind-brain TIE

- Hind-brain stroke (eg Wallenberg’s syndrome, locked-in syndrome)

20
Q

Nonischemic (local) symptoms of carotid artery dissection

A
  • Horner’s syndrome
  • Pulsatile tinnitus
  • Cranial nerve (CN) palsies (usually IX-XII)
21
Q

Signs of Horner’s syndrome

A
  • Ptosis
  • Anhidrosis
  • Miosis
22
Q

Ptosis

A

Drooping of upper eyelid

23
Q

Anhidrosis

A

Absence of sweating of the face

24
Q

Miosis

A

Pupil constriction

25
Q

Ischemic symptoms of carotid artery dissection

A
  • Transient ischemic attack
  • Ischemic stroke (usually middle cerebral artery territory)
  • Retinal infarction
  • Amaurosis fugax (temporary loss of vision in one or both eyes)
26
Q

Components of the neurovascular physical exam

A
  • Blood pressure
  • BMI
  • Pulse check
  • Neuro exam
  • Functional positional tests
  • Ligamentous tests (upper cervical)
  • Eye exam
27
Q

Parts of the upper motor neuron screen

A
  • Test for clonus
  • Hoffman’s reflex
  • Romberg test
  • Babinski sign
28
Q

Cranial nerve screen

A

See Week 2- Upper Quarter Screening Examination Flashcards

29
Q

Guiding principles for screening for mobility during the cervical exam

A
  • Incrementally increase movement and load

- Do not challenge the c-spine beyond what it would encounter during normal examination and treatment

30
Q

What is the next step if there are no S/S of cervical artery dysfunction?

A
  • Proceed with AROM testing

- Combined movement of extension w/ rotation

31
Q

Ways to decrease risk with manual therapy for the neck

A
  • Remember it’s not martial arts

- Pre-manipulative hold (see how the patient is handling the movement)

32
Q

Risk factors for stroke

A
  • BP
  • Atrial fibrillation
  • Smoking
  • Cholesterol
  • Diabetes
  • Exercise
  • Diet
  • Stroke in family
33
Q

Levels of risk for BP

A
  • High: >140/90 or unknown
  • Caution: 120-139/80-89
  • Low: <120/80
34
Q

Levels of risk for atrial fibrillation

A
  • High: Irregular heart beat
  • Caution: IDK
  • Low: regular heartbeat
35
Q

Levels of risk for smoking

A
  • High: smoker
  • Caution: trying to quit
  • Low: nonsmoker
36
Q

Levels of risk for cholesterol

A
  • High: >240 or unknown
  • Caution: 200-239
  • Low: <200
37
Q

Levels of risk for diabetes

A
  • High: yes
  • Caution: borderline
  • Low: no
38
Q

Levels of risk for exercise

A
  • High: couch potato
  • Caution: some exercise
  • Low: regular exercise
39
Q

Levels of risk for diet

A
  • High: overweight
  • Caution: slightly overweight
  • Low: healthy weight
40
Q

Levels of risk for hx of stroke in family

A
  • High: yes
  • Caution: not sure
  • Low: no
41
Q

Score results for stroke risk

A
  • High risk: >/= 3 –> ask about prevention
  • Caution: 4-6 –> reduce risk
  • Low risk: 6-8 –> under control
42
Q

Benefit/action of manual therapy for high risk of stroke

A
  • Benefit: Low predicted benefit

- Action: Avoid treatment

43
Q

Benefit/action of manual therapy for moderate risk of stroke

A
  • Benefit: Moderate predicted benefit

- Action: Avoid/delay treatment –> monitor and reassess

44
Q

Benefit/action of manual therapy for low risk of stroke

A
  • Benefit: Low/mod/high benefit

- Action: Treat with care/monitor for change or new symptoms

45
Q

Strategy for first visit with early onset neck pain

A
  • Treat thoracic spine via manipulation and ROM
  • Reassess 2nd visit
  • Cervical mob/manip if appropriate
46
Q

Timestamp for monitoring symptoms of neck pain

A
  • During history
  • During physical exam
  • During intervention
  • Prior to and after each phase of care
47
Q

Emergency procedures for neck pain following manipulation

A
  • DO NOT re-manipulate the neck
  • Observe patient –> any transient S/S or cervicogenic proprioceptive dizziness?
  • Call 911 (rescue and recovery position, record vitals, no food/drink, note time)

South College MSK 3 (22 decks)

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