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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
Ischemic symptoms of carotid artery dissection
- Transient ischemic attack - Ischemic stroke (usually middle cerebral artery territory) - Retinal infarction - Amaurosis fugax (temporary loss of vision in one or both eyes)
26
Components of the neurovascular physical exam
- Blood pressure - BMI - Pulse check - Neuro exam - Functional positional tests - Ligamentous tests (upper cervical) - Eye exam
27
Parts of the upper motor neuron screen
- Test for clonus - Hoffman's reflex - Romberg test - Babinski sign
28
Cranial nerve screen
See Week 2- Upper Quarter Screening Examination Flashcards
29
Guiding principles for screening for mobility during the cervical exam
- Incrementally increase movement and load | - Do not challenge the c-spine beyond what it would encounter during normal examination and treatment
30
What is the next step if there are no S/S of cervical artery dysfunction?
- Proceed with AROM testing | - Combined movement of extension w/ rotation
31
Ways to decrease risk with manual therapy for the neck
- Remember it's not martial arts | - Pre-manipulative hold (see how the patient is handling the movement)
32
Risk factors for stroke
- BP - Atrial fibrillation - Smoking - Cholesterol - Diabetes - Exercise - Diet - Stroke in family
33
Levels of risk for BP
- High: >140/90 or unknown - Caution: 120-139/80-89 - Low: <120/80
34
Levels of risk for atrial fibrillation
- High: Irregular heart beat - Caution: IDK - Low: regular heartbeat
35
Levels of risk for smoking
- High: smoker - Caution: trying to quit - Low: nonsmoker
36
Levels of risk for cholesterol
- High: >240 or unknown - Caution: 200-239 - Low: <200
37
Levels of risk for diabetes
- High: yes - Caution: borderline - Low: no
38
Levels of risk for exercise
- High: couch potato - Caution: some exercise - Low: regular exercise
39
Levels of risk for diet
- High: overweight - Caution: slightly overweight - Low: healthy weight
40
Levels of risk for hx of stroke in family
- High: yes - Caution: not sure - Low: no
41
Score results for stroke risk
- High risk: >/= 3 --> ask about prevention - Caution: 4-6 --> reduce risk - Low risk: 6-8 --> under control
42
Benefit/action of manual therapy for high risk of stroke
- Benefit: Low predicted benefit | - Action: Avoid treatment
43
Benefit/action of manual therapy for moderate risk of stroke
- Benefit: Moderate predicted benefit | - Action: Avoid/delay treatment --> monitor and reassess
44
Benefit/action of manual therapy for low risk of stroke
- Benefit: Low/mod/high benefit | - Action: Treat with care/monitor for change or new symptoms
45
Strategy for first visit with early onset neck pain
- Treat thoracic spine via manipulation and ROM - Reassess 2nd visit - Cervical mob/manip if appropriate
46
Timestamp for monitoring symptoms of neck pain
- During history - During physical exam - During intervention - Prior to and after each phase of care
47
Emergency procedures for neck pain following manipulation
- 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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