Manual Therapy and cervical artery dysfunction

Brief summary: Cervical artery dysfunction (CeAD) may mimic many musculoskeletal presentations. This paper provides a comprehensive review of the best available evidence for risk assessment prior to manipulation of the cervical and upper thoracic spine. Consider CeAD with the following presentation: An uncharacteristic headache, and a neck trauma in the past month.

Key words: Cervical Artery Dysfunction (CeAD), High Velocity Thrust Techniques (HVT), Mobilisation, Dissection, Vertebral Artery, Internal carotid artery, Osteopathic Medicine.

This is an extensive review of the current literature and provides an excellent summary of key fndings and recommendations, for an important aspect of osteopathic practice. This is a good example of a literature review research method to help guide best practice.

The authors describe cervical artery dysfunction (CeAD) to include range of disorders. The link between cervical spine (CSp), high velocity thrust techniques (HVT) and CeAD, is an association, not a clear causal relationship.

CSp movement not just HVT are important factors and an increased length of the styloid process may be a risk factor to CeAD, together with trauma to the CSp.

The peak incidence of CeAD is between 34-54 years of age, and 61% of cases are spontaneous.

There is a risk of misdiagnosis with lack of clinical reasoning being a main factor, with reported adverse efects from manual therapy.

CeAD may mimic musculoskeletal complaints for example acute onset CSp pain.

Headaches associated with CeAD are typically unilateral, frontal-temporal and often with occipital pain. They tend to be throbbing and sharp, but most importantly, unlike anything experienced by the patient before.

The pain is often less than a week in onset, and if associated with ptosis, facial numbness and unsteadiness then immediate referral to the medical services is recommended.

Around 12-34% of cases are the result of trivial trauma e.g. sneezing or sport related injury. The authors strongly recommend considering CeAD for all trauma to the neck in the frst month, and check for the above signs and symptoms.

This article contains much useful information, but much is summarised in clear tables e.g., table 3 potential signs and symptoms of CeAD, table 4 Red Flags, and table 5 Clinical tests.

In summary, if patients complain of an uncharacteristic headache, and have had a neck trauma in the past month, consider the possibility of CeAD.

References

Vaughan, B, Moran, R, Tehan, P, Fryer, G, Holmes, M, Vogel, S & Taylor, A (2016) Manual Therapy and cervical artery dysfunction: Identifcation of potential risk factors in clinical encounters, International Journal of Osteopathic Medicine, vol 21: 40-50