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Re: Upper Cervical Ligament Testing
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Re: Upper Cervical Ligament Testing - June 23, 2005 5:02:00 AM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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manual tests for ANY cervical ligament damage are bunk. There is not a single high powered study out there comparing the manual test to a gold standard radiographic test. Each and every test is marred by external limiting factors.
So what would the "gold standard" radiographic test be? Well it depends on who you ask. In most large hospitals the test of choice will be an MRI. Flexion extension films are of great debate and seem "counter intuitive" most times as you ask the patient to move there head in both flexion and extension (as much as they can tolerate) and x ray it. Then you measure and look for abnormal findings (ie large predental space).
My issues with flexion extension views are that you are MOVING a potentially dangerous area, seems stupid and out dated. Sure, no single test is going to find these abnormalities, but that is all we have. No one even knows what 1. the clinical significance these injuries have 2. the frequency of injuries.
We theorize, but it will remain an unknown. I would bet the world of manual medicine weighs in too heavily on these tests and these injuries. You just don't have "unstable" spines without trauma (or congenital abnormality, but even then it is a rare rare finding).
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Upper Cervical Ligament Testing - June 23, 2005 5:12:00 AM
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jbeneciuk
Posts: 112
Joined: November 26, 2004
From: Jacksonville, FL
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man:..i'm really getting slammed on this topic.....JBeneciuk
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Re: Upper Cervical Ligament Testing - June 23, 2005 5:30:00 AM
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JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
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Jben-
Isn't that a good thing?
Wags,
Anyone in your field discuss issues of traumatic upper cervical instability, as opposed to fracture?
For example, I'm sure there are some cervical instability case studies out there in the lower C-spine, like jumped facets, etc, and I'm sure ER docs catch those all the time.
Anything you've ever seen or heard about as far as this upper cervical instability thing?
I think we've come along way recently in managment of trauma lately with things like the Canadian C Spine rule, but I haven't really heard anything about this supposed upper cervical instability. Does it even exist?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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