OBJECTIVE:This case describes the upper cervical chiropractic management of a patient with neck pain and headaches with a history of cervical artery compromise following a motor vehicle accident. BACKGROUND:A 54-year-old male with neck pain and headaches was seen in a chiropractic office. Eight months prior to his initial visit, the patient was involved in a motor vehicle accident (MVA) which resulted in partial dissection of his left internal carotid artery. The patient reported severe cervicalgia, headaches and painful restricted cervical motion. Physical exam and cervical imaging assessed acceptable risk for treatment and indicated altered axis of motion in the first cervical vertebrae (C1) relative to the occiput (Co). OUTCOMES:The patient was examined over a 6 month period and received a total of 5 Blair upper cervical chiropractic adjustments. Physical exam findings, the Numerical Rating Scale (NRS), the Neck Pain Disability Index (NDI) and the RAND-36 outcomes were used to track progress. The NRS, NDI and RAND-36 demonstrated positive changes in presenting symptoms. CONCLUSION:More investigation is needed to understand the relationship between a history of traumatic cervical artery compromise and the effectiveness and safety of upper cervical chiropractic care utilizing Blair protocol to manage latent symptoms.
OBJECTIVE:Valid, reliable, and low-cost tools to assess pain can enhance quantitative pain assessment in multiple settings. Therefore, we assessed the technical validity, concurrent validity, reliability, and treatment sensitivity of the Egyptian algometer, which is a low-cost pain assessment tool. We also examined clinicians' inter- and intra-rater reliability with this device. METHODS:Technical validity of the algometer was tested by comparing the algometer to German standard weights. We tested (concurrent validity and reliability of the algometer in young healthy participants (n = 20, 27.31 ± 4.13 years), treatment sensitivity in 9 participants with discogenic sciatica (45.11 ± 14.77 years), and inter- and intra-rater reliability of 3 physical therapists who conducted all the tests. A combination of intra-class correlation coefficients (ICC(2,1) and ICC (2,3)) and Bland-Altman plots were used for all the analyses. RESULTS:The Egyptian algometer (i) demonstrated a force bias of ≤ ±3% versus standard German weights; (ii) showed excellent concurrent validity and reliability (ICC > 0.9) versus Wagner algometer, and (iii) inter-and intra-rater reliability (r > 0.9) for the standard acupuncture points. The Egyptian algorithm was sensitive to capture treatment changes across different body acupuncture points in patients with discogenic sciatica (range SEM = 0.22 to 0.41; p = 0.008 to 0.021; and 95% CI = -0.176 to -2.275; Cohen's d = 0.29-0.39). DISCUSSION:The Egyptian algorithm is a low-cost, valid, and reliable device to assess pain in healthy young adults. Additionally, the Egyptian algorithm can effectively capture pain treatment response in individuals with discogenic sciatica.
BACKGROUND:T4 syndrome is described as a clinical pattern characterized by upper-extremity pain, glove-like paresthesia, diffuse head pain, and cervicothoracic discomfort without neurological deficits or structural musculoskeletal pathology. Although diagnostic criteria and underlying mechanisms remain poorly defined, the syndrome is still included in manual therapy education. Most explanatory models focus on segmental musculoskeletal dysfunction; however, from the perspective of contemporary pain science, these theories appear insufficient to explain the spectrum of clinical signs and symptoms observed in this patient group. METHODS:This narrative review summarizes the current literature on T4 syndrome, emphasizing the integration of contemporary pain neuroscience into explanatory models and its potential implications for clinical reasoning, diagnostic procedures, and treatment strategies. RESULTS:Available evidence suggests that the clinical presentation of T4 syndrome cannot be explained by a specific thoracic segmental dysfunction alone. Rather, the symptom constellation likely reflects a complex interaction of neurobiological mechanisms with a presumed but still unclear link to thoracic musculoskeletal structures. CONCLUSION:T4 syndrome is likely to represent a complex multidimensional upper quadrant clinical syndrome driven by multiple neurobiological mechanisms. From this perspective, it seems appropriate to consider the structural and functional thoracic findings within the context of a mechanism-based clinical reasoning process guiding multidimensional assessment and management. Such a framework could provide a base for further research on this topic, clarifying the nature of underlying mechanisms, the clinical profile and diagnostic terminology of this syndrome.
