Canadian C-spine rules
Any high risk factors
- -age greater than 65
- -dangerous mechanism (fall from 1 meter, MVA over 100km/hr(62mph), rollover, bike accident)
- -parestheias in extremities
If no high risk factors, then AROM checklist:
- -simple rear-end MVA
- -no mid line tenderness
- -ambulatory
- -non-immediate pain
If yes to above, then assess ROM, if less than 45*, radiographs indicated
Cervical pain with mobility deficits classification
Age less than 50
duration less than 12 weeks
symptoms isolated to neck
decreased cervical ROM
6 predictors of positive response to c/s manipulation
NDI less than 11.5 Bilateral symptoms Non-sedentary work Neck feels better with movement Extension doesn't aggravate symptoms Diagnosis was spondylolysis
4 of6=89% positive outcome
T/s manipuation for cervical pain (6 items)
Symptom duration less than 30 days No symptoms distal to shoulder Looking up doesn't aggravate symptoms FABQ-PA less than 12 Decreased upper thoracic kyphosis Cervical extension less than 30
3 items present=86% chance of success
CPR for cervical traction usage (5 items)
Peripheralization with lower cervical mobiliy testing Positive shoulder abduction sign Older than 55 ULTTa Relief with manual traction
4 or more present, increase from 44-94% success rate. +LR of 23.1
3 present +LR of 1.44
CPR to rule in/out CAD (5 items)
- Age >65 (55 for men)
- Known CVD
- Pain worse with exercise
- not reproduceable with palpation
- Patient believes cardiac origin
2 predictor variables met, Sn of .98
3 predictor variables met, Sn .87, Sp .8, +LR 4.52
Ankylosing spondylitis CPR (4items)
- stiffness of greater than 30 min
- improvement with exercise, not rest
- awakening due to pain in 2nd half of night only
- alternating buttock pain
2 met= Sn.7, Sp.81
3 met=Sn.33, Sp.94
Wanier’s cervical radiculopathy CPR (4 items)
- positive spurlings
- Ultta
- distraction
- cervical rotation less than 60 to involved side
all 4: +LR 30.3
3: +LR6.1
Potential predictors for shoulder pain improving with t/s manip? (4 items)
- pain free flexion of 127 or less
- GH IR of less than 53
- not on pain meds for shoulder
- negative neer
Red flags for metastatic cancer (5 items)
CA history night pain/pain at rest unexplained weight loss Age over 50 or under 17 failure to improve
Red flags for disc or vertebral infection? (4 items)
imunosuppression
prolonged fever over 100.4
IV drug use
recent UTI, cellulitis, pneumonia
Red flags for vertebral fx (6 items)
prolonged corticosteroid use mild trauma over age of 50 over 70 years old osteoporosis major trauma bruising over spine following trauma
Red flags for AAA (4 items)
pulsating mass in abdomen
history of atherosclerosis
throbbing, pulsing back pain at rest or in sitting
older than 60
CPR for lumbar manip
- no symptoms distal to knee
-less than 16 days
FABQ-work less than 19
-hypomobile lumbar segment
-at least 1 hip has 35+ degrees of IR
SIJ CPR
Thigh thrust compression distraction sacral thrust Gaenslan
3/5= SN.91, Sp.87
Patients must not centralize to use CPR
SIJ CPR 2
Distraction Compression FABER thigh thrust Gaenslan
if less than 3 are positive, between 72 and 99% chance of no SIJ pain
Hip OA CPR
pain IR less that 15 pain with IR PROM morning stiffness of up to 1 hour older than 50
Stenosis CPR (5 items)
bilateral symptoms leg pain worse than back pain pain during standing/walking pain relief with sitting older than 48.
Sp: 3 test: .88
Cauda equina characteristics (5)
saddle anesthesia bladder dysfunction sexual dysfunction bowel dysfunction neurological deficits of LE
Ottowa knee (5 items)
Age greater than 55 Isolated patellar tenderness Tenderness of fibular head Inability to flex beyond 90 Inability to bear weight immediately and in ED
Meniscal Pathology Composite score (5 items)
History of catching/locking Pain with forced hyperextension joint line tenderness Positive McMurray pain with maximal flexion
If all 5: 92.3% chance of meniscus tear
3/5: 75%
Strongest tests for PFPS
pain with isometric quadriceps contraction
pain with squatting
pain with palpation
2/3= +LR 4.0
Carpal tunnel CPR (5 items)
- Age over 45
- Shaking hands for relief
- Wrist ratio (a/p->m/l)= .67 or higher
- Decreased thumb sensation
- Carpal tunnel severity score of 1.9 or higher
if all 5, +LR of 18.3, Sp 99%
CPR for ankle manip (4 items)
- symptoms worse in standing
- symptoms worse in evening
- navicular drop 5mm or greater
- distal tib/fib hypomobility
if 3/4 positive, 95% chance of success
However, large confidence interval.
