CHIR12007

Clinical Assessment and Diagnosis

Portfolio Exercises Week 2

CAD – Week 2
Exercise 1:
A. What are the signs and symptoms of cervical spine OA?

 Neck pain commonly associated with stiffness that lasts <30 min on awakening or after
inactivity.
 Dull, diffuse low level pain or aching but often not particularly severe pain
 Made worse with sudden movements or most physical activity involving the neck
 May radiate to the suboccipital, shoulder(s), interscapular, occasionally distally into the arms
in non-specific pattern
 Grating, crepitus or clicking with more advanced cases
 Aggravated by cold, damp and changes in barometric pressure

B. List the cervical spine joints affected by OA

 Discovertebral
 Facet
 Uncovertebral
 Atlantoaxial
 Atlantodental

C. What are appropriate treatment mechanisms available for Chiropractors?

a. Heat
b. Gentle exercise
c. Soft tissue therapy
d. Mobilisation; Traction; Manipulation dependant on degree and tolerance
e. Traction
f. Analgesics
g. Nutritional advice

Exercise 2:
Apply different types of pain descriptors to presented clinical cases including a descriptor of
the duration and origin (ie. Acute, subacute, chronic, radicular, radiating, visceral,
musculoskeletal/ mechanical)
A. Margaret, 62 yof, presents to your office with neck pain that began while painting her ceiling
2 months ago. She has recently developed pins and needles and pain into her thumb and
index finger. Subacute radicular

B. Tony, 32 yom, presents to your office with dull, aching lower back pain for the past couple
of days. This seems to be associated with the need to urinate very frequently and when he
does, there is pain and burning deep in his lower abdomen. Acute visceral
 C. Arthur, 78 yom, presents to your office with local pain in his left shoulder. His shoulder was
injured in the military years ago and he has had ongoing pain and discomfort. He has some
noticeable muscle wasting and weakness of the muscles around the shoulder, pain is not
elicited on cervical spine stress testing and there are no additional findings in the upper
extremity. Chronic musculoskeletal/ mechanical

Exercise 3
A. What is the difference between Whiplash and Whiplash associated disorder

 Whiplash-Acceleration-deceleration mechanism of energy transferred to the neck that

results in soft tissue injury that may lead to a variety of clinical manifestations including neck
pain and associated symptoms.  
 Whiplash associated disorder-Clinical syndrome characterized by neck pain and clusters of
physical and psychological symptoms.

B. What Whiplash classification are you most likely to see and care for in Chiropractic practice?
 Grade 0-2 possibly Grade 3

Exercise 4:
For each of the following cases, indicate if you would or would not choose to x-ray the
cervical spine using the Canadian C-Spine Rule.
A. Master Aye, 16yom, presents to your office with a stiff neck. He can’t recall anything that
started it. His neck was a little bit sore when he got up for school but has been getting worse
through the day. He did recall he fell off his mountain bike 2 days ago when he slid in the
mud but carried on riding with his mates for the afternoon. He is otherwise fit and healthy.
No past episodes of neck pain. He has no dizziness, nausea, tinnitus or other associated
symptoms. His vision is fine. Your examination is generally unremarkable. Range of motion is
only slightly limited on lateral flexion bilateral, rotation, flexion and extension are fine. No

B. Ms Bee presents to your office with neck pain that radiates to the right shoulder for the last
18 hours. Yesterday she slipped on wet concrete and fell down a flight of stairs hitting her
head on the wall on the way down. You gently palpate her neck and note exquisite midline
tenderness at the C5 spinous process. You are unable to perform any further tests as she is
guarding her neck and says she can’t move in any direction. Yes

C. Mr See, 68yom, presents to your office with ongoing neck pain, quite bad for the past 3
weeks and his middle three fingers are numb. He has a hard time recalling events specifically
however, he did have a blackout a few weeks ago and fell backward hitting his head on the
concrete steps. He was taken to A&E and told he had no brain injury. Yes

D. Ms DeBarne, 42 yof, presents to your office with neck pain. She was stopped at a red light
yesterday and the car behind her slammed on it’s brakes but hit her from behind. She’s
annoyed that he only damaged her bumper and did not write the car off. You notice she is
looking around your office quite well and doesn’t appear too distressed. She has no
additional symptoms and considers herself well although a little overweight. On exam, range
of motion is normal and all other parts of the exam are unrewarding. No

Exercise 5:
Complete the following Chart

Nerve Clinical
C2 Eye or ear pain; HA
C3, C4 Vague neck pain, trapezius tenderness and spasm
C5 Neck, shoulder, scapula pain. Lateral arm paraesthesia. Affects shoulder
abduction and elbow flexion; May be weak shoulder flexion, external rotation &
forearm supination. Decreased bicep reflex
C6 Neck, shoulder, scapula pain. Paraesthesia forearm, lateral hand, lateral 2 digits.
Affects elbow flexion and wrist extension. Decreased brachioradialis reflex
C7 Neck and shoulder pain; Paraesthesia posterior forearm and third digit; Affects
elbow extension and wrist flexion. Decreased triceps reflex
C8 Neck and Shoulder pain. Paraesthesia medial forearm, medial hand, medial 2
digits; Weak finger flexion, grip and thumb extension
T1 Neck and shoulder pain; Paraesthesia medial forearm. Weak finger abduction
and adduction