Cervical Myelopathy CPR
Cooke et. al CPR Rule - 5 criteria
Gait disturbance
+ Hoffman Tests
+ Inverted Supinator Sign
+ Babinski Test
Age >45 years
“45 CORD COMES ALIVE”
3/5 criteria +LR of 30
4/5 criteria +LR infinite
1/5 criteria was very sensitive
0/5 criteria confidently rules out cervical myelopathy
Carpal Tunnel CPR
- Shaking hands improves symptoms
- Wrist Ratio Index >.67
- Symptom Severity Score >1.9
- Diminished sensation in the median nerve sensory field of thumb
- Age >45 years (MID-LIFE - MEDIAN NERVE)
With <or=3 positives sensitivity is 98%
With 4 positives probability is 80%
CPR for Cervical Intermittent Traction
CPR for Intermittent Traction
“Fifty-five, traction thrives, 5 factors.”
1. Age >55
2. + shoulder abduction test (alleviation of symptoms when resting hand on head symptoms - relieving pressure on cervical nerve roots)
3. + ULTTA
4. + Distraction Test
5. Symptom peripheralization with PA testing of the lower cervical spine
3 or more +LR 5, 4 or more +LR 23
Cervical Radiculopathy CPR
- Positive Upper Limb Tension Test A
- Involved cervical rotation < 60 degrees
- Positive Distraction Test
- Positive Spurling’s A
3 positives probability is 65%
4 positives probability is 90%
Meniscal Pathology Composite Score/CPR
- History of catching or locking reported by the patient
- Joint line tenderness
- Pain with forced hyperextension (modified bounce home test)
- Pain with maximal passive knee flexion
- Pain or audible click with McMurray maneuver
MENI5CUS
3/5 PPV 77%
5/5 PPV 92%
Lumbar Manipulation CPR
- Duration of symptoms < 16 days
- At least one hip with > 35° of internal rotation
- Lumbar hypomobility
- No symptoms distal to the knee
- FABQ-W score < 19
3/5 probability of success 68%
4/5 is 95%
Hip Mobilizations for Knee OA CPR
Hip mobilizations for knee OA CPR
- Hip or groin pain or paresthesia
- Anterior thigh pain
- Passive knee flexion less than 122 degrees
- Passive hip medial (internal) rotation less than 17 degrees
- Pain with hip distraction
1 factor probability of success is 91%
2 factors probability of success is 98%
Sacroiliaic Joint Pain CPR
- SI Distraction
- SI Compression
- Thigh Thrust
- Galensen’s
- Sacral Thrust or Patrick’s(FABER)
3 positives 91% sensitive and 78% specific
SIMILAR CLUSTER ALSO WITH Patrick’s (FABER) Test –> Both are 3+ variables
Whiplash Injury Prognosis CPR
NDI of ≤32% who are younger (≤35) tend to make a full recovery.
A high NDI (≥40%) who are older (≥35) AND have post-traumatic stress symptoms (a hyperarousal subscale score of at least 6) tend to have moderate to severe chronic issues.
Everyone else falls somewhere in between, where mild pain or disability may persist at one year after the injury.
**32 GOOD 40 POOR **
DVT Well’s Criteria (10 criteria)
- Active cancer (patient receiving treatment for cancer within the previous 6 mo or currently receiving palliative treatment) +1
- Paralysis, paresis, or recent plaster immobilization of the lower extremities +1
- Recently bedridden for 3 days or more, or major surgery within the previous 12 wk requiring general or regional anesthesia +1
- Localized tenderness along the distribution of the deep venous system +1
- Entire leg swollen +1
- Calf swelling at least 3 cm larger than that on the asymptomatic side (measured 10 cm below tibial tuberosity) +1
7 . Pitting edema confined to the symptomatic leg +1
- Collateral superficial veins (nonvaricose) +1
- Previously documented deep-vein thrombosis +1
- Alternative diagnosis at least as likely as deep-vein thrombosis -2
> 3: High Probability
1-2: Moderate Probability
0: Low Probability
Cervical Manipulation CPR
Cervical Manipulation Treatment CPR
- Symptom duration <38 days
- Positive expectation that manipulation will help
- Side to side difference in cervical rotation of 10 degrees or more
- Pain with PA spring testing of middle cervical spine
3 out of 4 factors highly sensitive and specific to identifying positive response to cervical manipulation
Knee OA CPR
Clinical only - knee pain and at least 3/6
- Age > 50 (50 friction)
- Morning stiffness < 30 mins.
- Crepitus with active motion
- Bony tenderness
- Bony enlargement
- No palpable warmth
+LR 3.1, -LR 0.1
Rockwood Classificaiton
Rockwood Classifications
Type I: AC ligament sprain only, no radiographic changes, no clavicle elevation
Type II: AC ligament rupture, CC ligaments sprained, mild clavicle elevation
Type III: AC ligament rupture and CC ligament rupture, clavicle elevated but <twice the normal from the clavicle to the coracoid process
Type IV: posterior displacement of clavicle into trapezius
Type V: clavicle elevation >twice normal corcoclavicular distance
Type VI: inferior displacement of clavicle, often with neural injury
What are 5 constructs for Neck Pain prognosis and cut-off scores(4)?
- NPRS >=6
- NDI >=30%
- Pain Catastrophizing Scale >= 20
- Impact of Events Scaled-Revised >=33 (PTSD screening)
- Cold Hyperalgesia
“Six, three, two, thirty-three.”
“63-year-old, catastrophizing, stressed, sensitive to cold.”
Thoracic Manipulation for Neck Pain CPR
- No pain with cervical extension
- Cervical extension limited to 30
- no symptoms distal to the shoulder
degrees or less - Symptoms <30 days
- FABQ-PA <12.5
- decreased upper thoracic kyphosis
6 ITEMS NEED 3/6
What are score outcomes for Wells Criteria for DVT?
</= 1: DVT unlikely
>/= 2: DVT likely
What results in a negative score on Well’s Criteria for DVT?
-2
Alternative diagnosis to DVT as likely or more likely
Hip OA diagnostic cluster
> 50 yo
anterior or lateral WB pain
morning stiffness <1 hour
hip IR <24° or
hip IR and flx 15° < contralateral hip
pain with passive IR
