Examination of the cervical region
Cervical Arterial Dysfunction (CAD) in patients presenting with neck complaints is a rare event, but critical when considering the application of cervical spine manipulation techniques. The vertebral artery test is a very commonly used test prior to manipulation. However, an important principle of the assessment is that clinicians cannot rely on the results of one test to draw conclusions, in this case regarding the presence or risk of CAD. Thus, this paper aims to provide a framework based on a risk: benefit analysis, which will guide clinicians in the assessment of the cervical region for potential CAD.
A lot of serious conditions in early stages may mimic musculoskeletal problems, thus a neuro-vasculogenic hypothesis must be thoroughly examined. During the assessment the clinician should evaluate the blood pressure since hypertension is a high risk factor; cervical spine instability (anterior shear test, tectorial membrane distraction, alar ligament tests or through a sequence of active to passive with overpressure and accessory movement tests); possible upper motor neuron lesion, asymmetry in the arteries et cetera.
Cervical spine manipulation may carry the potential for serious neurovascular complications; therefore clinicians should take precautions measures and aim to exclude any vasculogenic cause prior to treatment.
> From: Rushton et al., Man Ther 19 (2014) 222-228. All rights reserved to Elsevier Ltd.. Click here for the Pubmed summary.