Flashcards in Cervical Manual Therapy Deck (43)
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1
What percentage of cervical artery dissection cases are of the internal carotid artery?
54 %
2
What percentage of cervical artery dissection cases are of the vertebral artery?
46 %
3
What percentage of cervical artery dissections are classified as spontaneous?
61 %
4
What percentage of cervical artery dissections were associated with trauma/ trivial trauma?
30 %
5
What percentage of cervical artery dissections were associated with cervical spine manipulation?
9 %
6
How often does a stroke occur following cervical spine manipulation?
- Varies from study to study
1:10,000 --> 1:5.85 Million
7
Is it more dangerous to drive in your car or to recieve a c-spine manipulation?
Driving in car
8
How likely is riding an airline to be fatal?
1:8 million
9
How likely is the development of a GI bleed while receiving NSAIDS?
4:1,000
10
Is a cervical manipulation or an NSAID more likely to be fatal?
NSAIDS 4 times more risky than the most severe c-spine manip statistics
11
Is there more evidence for C-spine manipulation or other therex type techniques for neck pain?
C-spine manips
12
Are mobilizations, traction, PROM, and strengthening risk free?
- No.
13
At which vertebra and above is the vertebral artery most at risk for dissection?
C2
14
What combination of motions is thought to be the most stressful to the vertebral artery?
- Contralateral rotation with extension
15
What is the mechanism of stroke following a cervical manipulation?
- Stretch/ pinch separates inner and outer lining of the artery leading to an internal bleed
- Thrombus forms --> Dislodges or flakes off to become an embolus
- Travels to small diameter arteries
- Causes ischemia/ infarct
16
Is stroke following dissection of the vertebral artery immediately apparent?
- Not always; it can take time
17
Why is the incidence of manipulation induced stroke difficult to obtain?
- Under-reported in literature
- Delay between manipulation and stroke clouds the correlation and causation
- Dissection may have been in process leading to the practitioner to perform the manipulation
18
How is the Vertebral Basilar Artery Insufficiency test performed?
- Place patient into end-range rotation with some possible distraction and/or extension.
- Hold for 10 seconds
19
Is the Vertebral basilar Artery Insufficiency test valid and reliable?
- Not sensitive or specific
20
What are the 10 signs of VBI (5 Ds, 3 Ns, 1 H, and 1 A)?
- Dizziness
- Drop Attacks
- Diplopia
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus
- Headache
- Hearing Disturbances
21
What is dysarthria?
- Slurred speech
22
What is dysphagia?
- Trouble swallowing
23
Where is numbness typically felt in patients with VBI?
- Around mouth, or one side of the face or body
24
What may occur instead of a headache if the VBI is sudden or severe?
- Neck pain
25
What is an example of the type of hearing disturbance that will be heard in a patient with VBI?
Tinnitus
26
What may be the ONLY sign in spontaneous cervical artery dissection?
- Pain
27
What artery do VBI screens not assess that is just as commonly dissected as the vertebral?
- The internal carotid
28
How strong is the evidence supporting the construct validity of the screening tests to predict the occurrence of VBI?
- No evidence
29
What are 5 signs in the patient's history that are risk factors for VBI?
- Hypertension (>180/100)
- Migraine
- Smoking
- Trauma
- Ateriosclerosis
30
