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CHIR12007

Clinical Assessment and Diagnosis


Por:olio Exercises Week 2

CAD – Week 2

Exercise 1:

A. What are the signs and symptoms of cervical spine OA?

Stiffness that lasts <30min in upon waking. Diffuse, low level pain or aching but no severe
pain. Radiation to sub occipital muscles & shoulders. Grating, crepitus or clicking in more
advanced cases. Agg: sudden movements or activities involving the Cx, cold/damp changes
in barometric pressure. Rel: heat, movement, NSAID’s. May lead to myelopathy or
radiculopathy.

B. List the cervical spine joints affected by OA

Discovertebral 

Facet

Uncovertebral 

Lateral atlantoaxial

Atlantdental


C. What are appropriate treatment mechanisms available for Chiropractors?

a. Heat

b. Gentle exercise

c. Soft tissue therapy

d. Mobilisation; Traction; Manipulation dependant on degree and tolerance

e. Traction

f. Analgesics

g. Nutritional advice

Exercise 2:

Apply different types of pain descriptors to presented clinical cases including a descriptor of
the duration and origin (ie. Acute, subacute, chronic, radicular, radiating, visceral,
musculoskeletal/ mechanical)

A. Margaret, 62 yof, presents to your office with neck pain that began while painting her
ceiling 2 months ago. She has recently developed pins and needles and pain into her
thumb and index finger.

A: Subacute, localised somatic neck pain with radicular pins and needles (neurological pain)
into proximal upper extremities.
B. Tony, 32 yom, presents to your office with dull, aching lower back pain for the past
couple of days. This seems to be associated with the need to urinate very frequently
and when he does, there is pain and burning deep in his lower abdomen

A: Acute, somatic localised back pain, referring visceral pain into lower abdomen.

C. Arthur, 78 yom, presents to your office with local pain in his left shoulder. His
shoulder was injured in the military years ago and he has had ongoing pain and
discomfort. He has some noticeable muscle wasting and weakness of the muscles
around the shoulder, pain is not elicited on cervical spine stress testing and there are
no additional findings in the upper extremity.

A: Chronic, somatic left shoulder pain.

Exercise 3

A. What is the difference between Whiplash and Whiplash associated disorder

A: Whiplash refers to the acute mechanism of energy transferred to the neck that results in a
soft-tissue injury and encompasses variety of clinical manifestations. While WAD is due to
the same mechanism, it is the resultant disorder from the original whiplash injury (developed
after).

B. What Whiplash classification are you most likely to see and care for in Chiropractic
practice?

A: WAD.

Exercise 4:

For each of the following cases, indicate if you would or would not choose to x-ray the
cervical spine using the Canadian C-Spine Rule.

A. Master Aye, 16yom, presents to your office with a stiff neck. He can’t recall anything
that started it. His neck was a little bit sore when he got up for school but has been
getting worse through the day. He did recall he fell off his mountain bike 2 days ago
when he slid in the mud but carried on riding with his mates for the afternoon. He is
otherwise fit and healthy. No past episodes of neck pain. He has no dizziness,
nausea, tinnitus or other associated symptoms. His vision is fine. Your examination is
generally unremarkable. Range of motion is only slightly limited on lateral flexion
bilateral, rotation, flexion and extension are fine.

A: No need to perform a radiographic examination.


B. Ms Bee presents to your office with neck pain that radiates to the right shoulder for
the last 18 hours. Yesterday she slipped on wet concrete and fell down a flight of
stairs hitting her head on the wall on the way down. You gently palpate her neck and
note exquisite midline tenderness at the C5 spinous process. You are unable to
perform any further tests as she is guarding her neck and says she can’t move in any
direction


A: Yes there is a need to perform a radiographic examination.


C. Mr See, 68yom, presents to your office with ongoing neck pain, quite bad for the past
3 weeks and his middle three fingers are numb. He has a hard time recalling events
specifically however, he did have a blackout a few weeks ago and fell backward
hitting his head on the concrete steps. He was taken to A&E and told he had no brain
injury


A: Yes there is a need to perform a radiographic examination.

D. Ms DeBarne, 42 yof, presents to your office with neck pain. She was stopped at a
red light yesterday and the car behind her slammed on it’s brakes but hit her from
behind. She’s annoyed that he only damaged her bumper and did not write the car
off. You notice she is looking around your office quite well and doesn’t appear too
distressed. She has no additional symptoms and considers herself well although a
little overweight. On exam, range of motion is normal and all other parts of the exam
are unrewarding.

A: No need to perform a radiographic examination.

Exercise 5:

C2: Eye or ear pain, HA.


C3-4: Vague neck pain, trapezius tenderness/spasm.
C5: Neck, shoulder, scapula pain. Lateral arm paresthesia. Affects shoulder abduction and
elbow flexion. May be weak shoulder flexion, ER and forearm supination. Hyporreflex of
bicep.
C6: Neck, shoulder, scapula pain. Forearm, lateral hand and lateral 2 digits have
paresthesia. Affects elbow and wrist extension. Hyporreflex of brachioradialis.
C7: Neck, shoulder pain. Posterior forearm and third digit have paresthesia. Affects elbow
and wrist flexion. Hyporreflex of tricep.
C8: Neck, shoulder pain. Medial forearm, medial hand and medial 2 digits have
paresthesia. Weak finger flexion, grip and thumb extension.
T1: Neck, shoulder pain. Medial forearm has paresthesia. Weak finger abduction and
adduction.
Complete the following Chart


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