Cervical Instability: Difference between revisions
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== Clinical Presentation == | == Clinical Presentation == | ||
Mintken et al described the cardinal symptoms of clinical instability: drop attacks, facial or lip paresthesias, bilateral or quadrilateral limb paresthesias, or nystagmus.<sup>4</sup> These signs and symptoms are usually provoked with active or passive movement of the head or neck. Furthermore, in their case study, they address other secondary impairments such as dizziness and bilateral blurred vision.<br> In a Delphi survey study, Cook et al reported that physical therapists attribute the following symptoms with cervical instability: | |||
*“intolerance to prolonged static postures” | |||
*“fatigue and inability to hold head up” | |||
*"better with external support, including hands or collar" | |||
*"frequent need for self-manipulation" | |||
*"feeling of instability, shaking, or lack of control" | |||
*"frequent episodes of acute attacks" | |||
*"sharp pain, possibly with sudden movements"<sup>5</sup><sup></sup> | |||
Since there is little evidence supportive of clinical tests for cervical spine instability, recognition of these symptoms along with clinical judgment could warrant referral. During examination, it is important to collect a thorough history from the patient to understand the patient’s chief complaint, signs and symptoms - neural or vascular compromise, duration and pain level. | |||
== Diagnostic Procedures == | == Diagnostic Procedures == |
Revision as of 22:12, 19 March 2011
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Clinically Relevant Anatomy[edit | edit source]
The cervical spine is structurally distinguished by differences between the upper cervical spine (C1 and C2) and the lower cervical spine (C3-C7) segments. Anatomical and functional distinctions allow for differences in segmental mobility and movement direction. The upper cervical spine allows for a greater degree of rotation with some frontal and sagittal movement. In contrast, the lower cervical spine moves in flexion-extension and inclination-rotation.1
[edit | edit source]
Mechanism of Injury / Pathological Process[edit | edit source]
Traumatic
- Whiplash
- Motor vehicle accident
- Head/neck surgery
Systemic
- Recent upper respiratory infection
Congenital
- Down syndrome
- Juvenile rheumatoid arthritis
- Ankylosing spondylosis
- Cerebral palsy
- Neurofibromatosis
- Os odontoideum
- Klippel-Feil syndrome (KFS)
Clinical Presentation[edit | edit source]
Mintken et al described the cardinal symptoms of clinical instability: drop attacks, facial or lip paresthesias, bilateral or quadrilateral limb paresthesias, or nystagmus.4 These signs and symptoms are usually provoked with active or passive movement of the head or neck. Furthermore, in their case study, they address other secondary impairments such as dizziness and bilateral blurred vision.
In a Delphi survey study, Cook et al reported that physical therapists attribute the following symptoms with cervical instability:
- “intolerance to prolonged static postures”
- “fatigue and inability to hold head up”
- "better with external support, including hands or collar"
- "frequent need for self-manipulation"
- "feeling of instability, shaking, or lack of control"
- "frequent episodes of acute attacks"
- "sharp pain, possibly with sudden movements"5
Since there is little evidence supportive of clinical tests for cervical spine instability, recognition of these symptoms along with clinical judgment could warrant referral. During examination, it is important to collect a thorough history from the patient to understand the patient’s chief complaint, signs and symptoms - neural or vascular compromise, duration and pain level.
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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Case Studies[edit | edit source]
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References[edit | edit source]
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