Here’s why we think it matters:

 

Put simply, it really highlights the importance of good clinical reasoning. The patient in this case was not even referred to PT for “neck pain,” she was referred for shoulder pain.  However, the therapist recognized that something was “not right” with the patient’s cervical spine. As one of the studies in this case report stated, “neurological signs and symptoms may not be present in subluxations of up to 10 mm.” (1,2) Due to the severity of the patient’s posturing and history, the therapist was not able to do a complete hands on evaluation of the patient. This patient was lacking what we could consider classic signs of instability and the author was unable to perform all the physical testing they would have liked to.

However, the author of this study, through a good history and clinical reasoning skills, was able to make the appropriate referrals back to the doctors who recommended surgery to stabilize the patient’s upper cervical region. The patient declined surgery due to risk factors, but was able to get a power wheel chair that provided more appropriate (safe) head support.

 

Do you feel like you have the clinical reasoning skills to recognize when things are not as they seem?  Come and join us on on one of our cervical  courses to learn how to assess patients using both a hands on and a hands off approach when appropriate.

1. Kramer J, Jolesz F, Kleefield J. Rheumatoid arthritis of the cervical spine. Imag Rheum Dis.1991;17:757–72

2. Bouchaud-Chabot A, Lioté F. Cervical spine involvement in rheumatoid arthritis. A review. Joint, Bone, Spine. 2002;69:141–54.[CrossRef], [PubMed], [Web of Science ®]