Positive Cervical Artery Testing in a Patient with Chronic Whiplash Syndrome: Clinical Decision-Making in the Presence of Diagnostic Uncertainty

Abstract

This case report describes the diagnosis and management of a 43-year-old female patient who had sustained an injury to her neck in a motor-vehicle accident two years earlier. The major symptoms described by the patient included headache and neck pain, but history and examination also revealed signs and symptoms potentially indicative of cervical artery compromise. Physical therapy management initially consisted of soft tissue and non-thrust joint manipulation of the lower cervical and thoracic spine, specific exercise prescription, and superficial heat. Cervical vascular compromise was re-evaluated by way of the sustained extension-rotation test. When at the fifth visit this test no longer produced symptoms potentially indicative of vascular compromise, upper cervical diagnosis and management consisting of soft tissue and non-thrust joint manipulation was added. A positive outcome was achieved both at the impairment level and with regard to limitations in activities, the latter including increased performance at work, a return to previous reading activities, improved length and quality of sleep, and greater comfort while driving. At discharge, the patient reported only occasional pain and mild limitations in activities. This report describes the positive outcomes in a patient with chronic whiplash syndrome; however, its main emphasis lies in the discussion and critical evaluation of clinical reasoning in the presence of diagnostic uncertainty with regard to cervical artery compromise.

Can the transverse foramen/vertebral artery ratio of double transverse foramen subjects be a risk for vertebrobasilar transient ischemic attacks?

“…), with cervical spine trauma estimated to occur in 20% of these motor‐vehicle accidents (Graziano et al. ), and with almost four million emergency department visits each year in the USA alone due to motor‐vehicle collisions (McLean et al. ).…”

Whiplash Injuries to the Cervical Spine

“…Kerry, Taylor [68] считают, что хлыстовая травма может вызывать поражение интимы сонной артерии. Graziano et al [43] определили, что в 70 из 80 случаев повреждение интимы является причиной вертебробазилярной ишемии при ДТП. Нет данных, которые бы имели диагностическое и прогностическое значение для широкого использования, позволяли бы отражать поражение артерии.…”

“…Нет данных, которые бы имели диагностическое и прогностическое значение для широкого использования, позволяли бы отражать поражение артерии. В то же время клиницисты при ведении пациентов, которые имеют симптомы, потенциально связанные с дисфункцией интимы каротидных артерий, сталкиваются с возможностью индуцированного поражения интимы артерии, но диагностически это недостаточно ясно [43].…”

Physiotherapists' lived experiences of decision making in therapeutic encounters with persons suffering from whiplash‐associated disorder: A hermeneutic phenomenological study

“…Recognising the traumatic nature of the injury, NICE also recommends psychological strategies for persons with acute of post‐traumatic stress. Furthermore, whiplash can lead to rare but serious pathoanatomical sequalae such as craniovertebral instability (Rebbeck & Liebert, 2014) and cervical artery dysfunction, which may lead to diagnostic challenges and uncertainty (Graziano, Nitsch, & Huijbregts, 2013). These specific diagnostic challenges and the wide reaching effects on sufferers highlight the need for an individualised approach to physiotherapy management and the complexity of person‐centred decision making.…”