28.03.19 Clinical Hours

For today’s clinic I asked a fellow Marjon student who was complaining of neck pain to come into the clinic, so I could go through a full cervical spine objective assessment. Before the session I wrote a complete objective assessment guidance sheet for the cervical spine with the help of lecture notes, physiopedia and the orthopaedic special tests book by Konin et al. (2016). This included observation (general posture, head position, spine position), clearing above/below joints with AROM (Shoulder, Scapula and thoracic spine), palpation (spinous and transverse processes of c1-c7), AROM, PROM, neurological assessment for potential nerve compression (dermatomes, myotomes, reflexes, neurological tests) and finally PA accessory movements (assessing vertebrae mobility and pain) and other special tests such as the tinels sign test which tests for potential brachial plexus pathology.

While going through my assessment sheet on the patient the clinic supervisor advised me not to use the Vertebral artery test which tests for vertebrobasilar insufficiency (VBI) even if the patient has had no history of VBI. He explained that by doing this test you are essentially cutting of the blood flow of the vertebral artery which could lead to a stroke or initiate VBI symptoms (by turning the head) and in the worst-case scenario even rupture the artery. As such he suggested the risks outweigh the benefits and a better way for screening for VBI is by using the subjective assessment to find out if the patient has neck pain and dizziness symptoms which together are an indication of VBI.

After the patient left, I then reviewed my assessment sheet and decided to remove the vertebral artery test after finding a study by Hutting et al. (2013) stating that the sensitivity was very low (0-57%) but had good specificity (67-100%). Even with the good specificity score they concluded that this test was of weak clinical value. Furthermore, for future sessions and my upcoming exam I need to revise the application of special tests (Spurling test, Valsalva manoeuvre) and upper limb neuro-tension tests (median, ulnar and radial nerve bias). This assessment took longer than it should have done, due to my inefficiency and as such will need a lot more practice. I will use the help of the special tests book by Konin, Lebsack, Valier, & Isear (2016) and the Physiotutors YouTube channel to aid my revision.

Links:

Physiotutors youtube channel: https://www.youtube.com/user/Physiotutors/videos

References:

Hutting, N., Verhagen, A., Vijverman, V., Keesenberg, M., Dixon, G., & Scholten-Peeters, G. (2013). Diagnostic accuracy of premanipulative vertebrobasilar insufficiency tests: A systematic review. Manual Therapy, 18(3), 177-182. doi: 10.1016/j.math.2012.09.009

Konin, J., Lebsack, D., Valier, A., & Isear, J. (2016). Special tests for orthopedic examination (4th ed., pp. 364-390). SLACK incorparated.

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