Article 3: Clustered Findings for Diagnosis of C/S Myelopathy

Intro: CSM Characteristics

• CSM has no single ___ sign or symptom

• What is the ONSET of CSM

• No single Pathognomonic S/S

• Onset:

  • Insidious with ling periods of episodic, stepwise progression

Intro: CSM Characteristics

• Presentation:

  • There is a ____ ____ of clinical findings from pt to pt

• CSM initially involves what 2 symptoms?

• Presentation:

  • Vast Array

• 2:

  • LE FIRST (LE weakness)

    • Gait related changes

  • Spasticity

Intro: CSM Characteristics

• As SC degeneration progresses, what is usually present?

  • 3 symptoms

• Lower Motor Neuron in UE

  • Loss of strength

  • Atrophy

  • Difficulty with finger movements

Intro: CSM Characteristics

• What are 4 additional clinical findings in CSM?

• Neck Stiffness

• Shoulder Pain 

• Paresthesia in Unilaterally or Bilaterally Arms or Hands

• Radiculopathic Signs 

Imaging:

• What type of imaging is the BEST method?

  • This form of imaging is BEST at confirming the presence of what 3 diagnoses?

• MRI

• 3:

  • Cervical Stenosis

  • SC Compression

  • Myeomalacia

Imaging:

• What does MRI express the amount of?

• Amount of compression places on the SC

  • HIGH SENSITIVITY (SNOUT)

Clinical Tests to Diagnose CSM:

• What is included in the cluster to diagnose CSM?

• Gait Deviation

• (+) Hoffman’s Test 

• Inverted Supinator Sign 

• (+) Babinski Test 

• Age: > 45 years 

Clinical Tests to Diagnose CSM:

• ⅕ Positive Test =

• ⅗ OR ⅘ Positive Test =

• ⅕ Positive Test = RULE OUT CSM

• ⅗ OR ⅘ Positive Test = RULE IN CSM 

Clinical Tests to Diagnose CSM:

• To diagnose CSM, combination of what 2 things is required?

• MRI Findings and Clinical Findings

Purpose:

• The purpose of this study was to:

  • Produce WHAT findings for a sample of patient using a clinical diagnosis as a reference standard for CSM.

• Cluster of Predictive Clinical Tests

Methods:

• Participants:

  • ____ Consecutive Patients 

  • T/F: All with Cervical Pain or Dysfunction were eligible for this study 

  • CSM Diagnosis was made by ______ surgeons 

• 249 Consecutive Patients 

• TRUE

• CSM Diagnosis was made by orthopaedic surgeons 

Methods:

• Pts with CSM typically presented how? (4)

• Older

• Longer Duration of Symptoms 

• Lower SF12 Scores (Genetics)

• Higher BMI Scores

Quiz Question:

According to Cook et al. what clinical tests when clustered together were most diagnostic for clinically identifying cervical myelopathy?

1. (+) upper limb tension test, cervical rotation <60 deg, positive spurlings, positive distraction test

2. (+) Babinski’s, gait deviation, (+) Hoffman’s, (+) inverted supinator sign, age >45

3. Chest pain, upper back pain, shortness of breath, arm numbness 

4. Neck disability index >40%, age <35, hyperarousal 

1. (+) Babinski’s, gait deviation, (+) Hoffman’s, (+) inverted supinator sign, age >45

Quiz Question:

True or False: In the article by C. Cook it is found the cervical myelopathy generally presents with lower extremity symptoms first including but not limited to: abnormal gait, spasticity, and lower extremity weakness

TRUE

Quiz Question:

True or False: The article by Cook et al. found that a negative finding from Babinski, Hoffman’s, Clonus, or hyperreflexia when tested alone is enough to rule out cervical myelopathy clinically.

FALSE

Quiz Question:

The overall consensus of the article by Cooke et al. determined that:

1. The only way to accurately diagnose cervical myelopathy is via MRI 

2. Cervical myelopathy can be ruled out by performing individual neurologic specific clinical tests

3. Due to poor tests and measures clinically diagnosing cervical myelopathy is not possible

4. Physical therapists are capable of clinically recognizing patients with cervical myelopathy

1. Physical therapists are capable of clinically recognizing patients with cervical myelopathy

Quiz Question:

True or False: Cook et al., determined that the best way to determine if someone truly has cervical myelopathy is with the cluster of diagnostic testing found in this article.

FALSE