Inter-examinerreliability study of physical examination procedures to assess the cervical spine

Abstract Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.

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Identifiers Suggestive of Clinical Cervical Spine Instability: A Delphi Study of Physical Therapists

Physical Therapy ◽

10.1093/ptj/85.9.895 ◽

2005 ◽

Vol 85 (9) ◽

pp. 895-906 ◽

Cited By ~ 45

Author(s):

Chad Cook ◽

Jean-Michel Brismée ◽

Robert Fleming ◽

Phillip S Sizer

Keyword(s):

Cervical Spine ◽

Physical Examination ◽

Delphi Study ◽

Physical Therapists ◽

Survey Methods ◽

Clinical Information ◽

Neuromuscular Control ◽

External Support ◽

Cervical Spine Instability ◽

Therapy Assessment

Abstract Background and Purpose Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI. Subjects One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey. Methods This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI. Results The symptoms that reached the highest consensus among respondents were “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,” and “sharp pain, possibly with sudden movements.” The physical examination findings related to cervical instability that reached the highest consensus among respondents included “poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement,” “abnormal joint play,” “motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming,” and “aberrant movement.” Discussion and Conclusion The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.

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Bony ankylosis of the facet joint of the cervical spine in rheumatoid arthritis: Its characteristics and relationship to the clinical findings

Modern Rheumatology ◽

10.1080/14397595.2016.1265638 ◽

2016 ◽

Vol 27 (5) ◽

pp. 801-805 ◽

Cited By ~ 2

Author(s):

Haku Iizuka ◽

Yoichi Iizuka ◽

Koichi Okamura ◽

Yukio Yonemoto ◽

Tokue Mieda ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

Facet Joint ◽

Clinical Findings ◽

Bony Ankylosis

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Tropism of Sub-Axial Cervical Facet Joints Is Not Related to Segmental Movement during Active Movement or Therapist-Perceived Symptomatic Locations

Symmetry ◽

10.3390/sym13050739 ◽

2021 ◽

Vol 13 (5) ◽

pp. 739

Author(s):

Neil Tuttle ◽

Kerrie Evans ◽

Clarice Sperotto dos Santos Rocha

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Active Movement ◽

Facet Joints ◽

Segmental Mobility ◽

Limited Mobility ◽

Translational Movement ◽

The Difference ◽

Cervical Facet ◽

The Relationship

Tropism, or asymmetry, of facet joints in the cervical spine has been found to be related to degenerative changes of the joints and discs. Clinicians often assume that differences in segmental mobility are related to tropism. The aims of this study were to determine the relationship between asymmetry of facet joints in the sub-axial cervical spine and (1) segmental mobility and (2) spinal levels perceived by therapists to have limited mobility. Eighteen participants with idiopathic neck pain had MRIs of their cervical spine in neutral and at the end of active rotation. Angular movement and translational movement of each motion segment was calculated from 3D segmentations of the vertebrae. A plane was fitted to the facet on each side. Tropism was considered to be the difference in the orientation of the facet planes and ranged from 1 to 30° with a median of 7.7°. No relationships were found between the extent of tropism and either segmental movement or locations deemed to be symptomatic. Tropism in the sub-axial cervical spine does not appear to be related to segmental mobility in rotation or to levels deemed to be symptomatic.

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Ultrasound-Guided and CT-Navigation-Assisted Periradicular and Facet Joint Injections in the Lumbar and Cervical Spine

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200705000-00014 ◽

2007 ◽

Vol 32 (3) ◽

pp. 254-257 ◽

Cited By ~ 2

Author(s):

Klaus Galiano ◽

Alois Albert Obwegeser ◽

Reto Bale ◽

Christoph Harlander ◽

Reinhold Schatzer ◽

...

Keyword(s):

Cervical Spine ◽

Facet Joint ◽

Ultrasound Guided ◽

Joint Injections

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Approach to the Cardiovascular Patient

10.2310/im.1074 ◽

2013 ◽

Author(s):

Catherine M. Otto ◽

David M Shavelle

Keyword(s):

Physical Examination ◽

Diagnostic Tests ◽

Clinical Status ◽

Correct Diagnosis ◽

Complete Evaluation ◽

Treatment Expectations ◽

Cardiovascular Patient ◽

Life Threatening ◽

Background History ◽

Cardiac Testing

The complete evaluation of the cardiovascular patient begins with a thorough history and a detailed physical examination. These two initial steps will often lead to the correct diagnosis and assist in excluding life-threatening conditions. The history and physical examination findings should be assessed in the overall clinical status of the patient, including the patient's specific complaints, lifestyle, comorbidities, and treatment expectations. This chapter discusses the cardiovascular conditions that frequently require evaluation: chest pain, dyspnea, palpitations, syncope, claudication, and cardiac murmurs; and reviews the background, history and physical examination, and diagnostic tests available for each. Diagnostic algorithms are provided, and the appropriate use of invasive and noninvasive cardiac testing for each condition is discussed. This review contains 8 highly rendered figures, 12 tables, and 52 references.

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Quality and Findings of Bitewing Radiographs among Twenty-Year-Old Conscripts in Finland

International Journal of Dentistry ◽

10.1155/2021/8894917 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Miika Hyvönen ◽

Arttu Jaakkola ◽

Tarja Tanner ◽

Jari Päkkilä ◽

Antti Kämppi ◽

...

Keyword(s):

Bone Loss ◽

Clinical Status ◽

Tooth Wear ◽

Cross Sectional Study ◽

Clinical Findings ◽

Caries Detection ◽

Marginal Bone Loss ◽

Cross Sectional ◽

Caries Diagnostics

Objectives. Bitewing radiographs are mainly used to confirm clinical findings in caries diagnostics. The objective here was to investigate the quality of bitewing radiographs after short brush-up training and additional findings besides caries in a low-caries population. Methods. The material of this cross-sectional study comprised 377 pairs of bitewing radiographs of 19- to 20-year-olds taken by dentists. Radiography was considered indicated if one dentinal caries lesion was present on clinical examination. A senior oral radiologist evaluated quality and diagnosed the findings afterwards unaware of clinical status. The association between variables was analysed using cross tabulation and chi-squared testing. Results. Almost half of the images were of compromised quality (44.1%). Dentinal caries lesions were detected in 82.3% and enamel lesions in 73.5% of the subjects. On average, the subjects had 1.7 (SD 0.52) dentinal lesions. Fillings were found in 81.8%, fractures/cracks in 11.7%, and attrition in 7.4% of the subjects. Signs of excessive bite force were recorded in 19.4%, whereas marginal bone loss was detected in 6.4%. No significant correlation was detected between fractures, attrition, and excessive bite forces. Conclusions. Effort must be taken to ensure high quality of bitewing radiographs. In addition to caries detection, bitewing radiographs offer additional value, such as detecting excessive bite forces, tooth wear, and marginal bone loss among young adults.

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Posterior Ligamentous Complex Reconstruction for Cervical Dislocation and Instability in Patients without Vertebral Fracture with Artificial Ligaments: A Technical Note

10.21203/rs.3.rs-103566/v1 ◽

2020 ◽

Author(s):

Chengyi Huang ◽

Beiyu Wang ◽

Hao Liu ◽

Tingkui Wu ◽

Kangkang Huang ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Fracture ◽

Neck Pain ◽

Facet Joint ◽

Spinous Process ◽

Posterior Ligamentous Complex ◽

Reconstruction Surgery ◽

Artificial Ligaments ◽

Cervical Surgery ◽

Patient Reported

Abstract Introduction: The posterior ligamentous complex (PLC) offers restraints to deformation in a complex and interconnected manner. The stability and range of motion (ROM) of the posterior cervical spine is greatly restricted when the PLC is damaged, even without bone disruptions. We describe a novel surgical technique, its advantages, and the postoperative condition of the first patient to use artificial ligament in a reconstruction surgery of PLC injuries in patients without lower cervical vertebral fracture. This technique aimed to fully retain the mobility of the injured segment based on spinal stability and apply dynamic reconstruction in patients’ treatment.Method: We present a detailed description of the reconstruction surgery with artificial ligaments performed on C4-6 PLC injuries in a 27-year-old male presented with neck pain and restricted movement following a high fall injury accompanied by impaired movement of limbs. Results: Immediately postsurgery, the patient’s neck pain and quadriparesis had been improved. The spinal canal decompression and cervical spine sequence results were satisfactory, the facet joint face was in a good position, and the spinous process spacing returned to normal. After three months of rehabilitation, the patient reported improvement of symptoms and the physical and imaging examination showed a significant improvement in the patient’s condition. The patient’s neck mobility motor function had improved further.Conclusion: The present data demonstrate that the novel technique for reconstruction of PLC injury is feasible and safe. However, familiarity with cervical anatomy and adequate experience in lateral mass screws placement during surgery is crucial for this procedure. Therefore, a highly experienced cervical surgery team is recommended to perform the surgery.

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Arthroscopic shoulder assessment in Turkish amateur boxers

Open Medicine ◽

10.2478/s11536-008-0079-x ◽

2009 ◽

Vol 4 (3) ◽

pp. 358-362

Author(s):

Hüseyin Özkan ◽

İbrahim Yanmış ◽

Mustafa Kürklü ◽

Ali Şehirlioğlu ◽

Servet Tunay ◽

...

Keyword(s):

Physical Examination ◽

Clinical Findings ◽

Subacromial Impingement ◽

Shoulder Injuries ◽

Pathological Findings ◽

Glenoid Labrum ◽

Arthroscopic Findings ◽

Shoulder Region ◽

Grade 3 ◽

The Brain

AbstractThe most common injuries reported in the literature regarding the sport of boxing are to the brain, eyes, kidneys and hands. Shoulder injuries have not been fully reported in the literature until recently, as a result we aimed to present our arthroscopic findings in amateur boxers. Ten amateur boxers with complaints of pain in the shoulder region and decreased performance during sportsplay were enrolled. They were evaluated by physical examination, radiology and arthroscopy. There were no clinical findings of instability. One patient was found to have subacromial impingement; six had crepitation at various degrees during shoulder movements. At arthroscopy, all patients had a variety of pathological findings. Five patients had Grade 1, three had Grade 2, and two had Grade 3 chondropathy. Various degrees of fraying of the anterosuperior and posterosuperior regions of the glenoid labrum were noted in all cases. Three patients had superior labrum anterior and posterior lesions, one patient had a posterior labroligamentous lesion, and one had chondral erosion in the anterosuperior portion of the humeral head. In conclusions, although the injury mechanism of the shoulder during boxing is unknown, this study shows that shoulder complaints in boxers should be considered as possible indicators of serious intra-articular lesions.

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Review and retrospective analysis of degenerative lumbosacral stenosis in 156 dogs treated by dorsal laminectomy

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0037-1617374 ◽

2008 ◽

Vol 21 (03) ◽

pp. 285-293 ◽

Cited By ~ 50

Author(s):

N. Suwankong ◽

G. Voorhout ◽

A. de Boer ◽

H. Hazewinkel ◽

B. Meij

Keyword(s):

Medical Records ◽

Joint Angle ◽

Facet Joint ◽

Cauda Equina ◽

Clinical Signs ◽

Clinical Findings ◽

Lumbar Pain ◽

German Shepherd ◽

Disc Protrusion ◽

German Shepherd Dog

SummaryThe medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.

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