Exam 2- Week 3 Flashcards
(23 cards)
what are the 2017 recommended CPR’s for neck pain, acute, subacute and chronic
acute: cervical manip and mob was a grade of C
subacute: cervical manip and mob was given a grade of B
chronic (both with headaches and radiating pain), C - spine manip and mob were given grades of B.
chronic neck pain with headaches, what interventions should be done
manip and mob, shoulder girdle and neck stretching, strengthening, and endurance exercises.
chronic neck pain with radiating symptoms, what should we do
traction, stretching strengthening and cervical and thoracic manip and mob
what are some cervical artery injuries
atherosclerosis, trauma or plaque
what is the predominant symptom in patients with arterial dissections, and why
pain, because the arterial walls are supplies with pain fibers.
what is the third most leading cause of death in this country, and what country leads this (and which has lowest)
STROKE
Mississippi and the Connecticut
which is more common, a vertebral artery or carotid artery stroke
common carotid
can cervical manip cause a stroke
yes, but rare
according to Smith 2003, what are some reasons to suspect that stroke from manip can happen
following chiropractic manip, those who had a stroke or TIA noticed an increase in pain with the adjustments. 2 had a stroke within minutes, and 6/7 had a dissection of the vertebral artery.
what is the average risk of adverse effects of a stroke
1 in 2 million
are there a large number of studies looking at stroke after a manipulation
no, since it is so rare, there are not many studies
what are the chances of having a vertebral artery dissection causing a stroke
1 in 100,000
rate of occurrences of all strokes
269/100,000
what is the reasoned estimate of risk from manip and stroke
1.3/100,000
when do physical therapist use cervical manipulation
with neck pain, headaches and dizziness.
what are the risks of NSAIDS and Tylenol
GI bleeding, 7600 deaths, 76,000 hospitalizations, and overdoses and deaths!
risk in context with C-spine manip, vigorous exercise, NSAIDS and NSAIDS with bleeding
.005-.9 (manip)
.002 (exercise)
NSAIDS 100-300 (bleeding: 20)
how do we proceed with neck patients,
look at the risk to reward ratio, and know the arterial anatomy. Also want to do a thorough exam, and check CN screen, observations and clinical reasoning.
where should we be most cautious with patients
new onset of neck pain complaints.
what are the symptoms of vertebral artery dissection
ipsilateral posterior neck pain and occipital HA, and maybe a root impairment (Rare)
ischemia signs: dizzy, nauseous, drop attacks, 5D’s and 2N’s. Hind brain TIE. Wallenberg’s syndrome.
what are the symptoms of carotid artery dissection
Horner’s syndrome (mitosis, ptosis, and anhidrosis)
pulsatile tinnitus, CN palsies (9-12), bruit, swap tender, neck welling, orbital pain, facial dryness (anhidrosis)
Ischemic: TIA, retinal infarction, amaurosis fugax (temporary vision loss).
what kinds of things do you do during a neuromuscular exam (7)
blood pressure, BMI, pulse check, Neuro exam, functional positional tests, ligamentous test (upper C-spine) and an eye exam
UMN lesion tests
Babinski, Hoffman, Clonus, Romberg
