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An Evidence-Based Approach to the Neck Assessment

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH1 Pierre Côté, DC, PhD2 Dr. Hamilton Hall, MD, FRCSC3

1is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor. 2Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). 3 is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract:Neck pain is a common musculoskeletal condition that frequently resolves spontaneously or with conservative treatment and only occasionally requires surgical intervention. The purpose of the neck examination is to determine if the etiology is neurological or mechanical pain, which determines treatment planning, and then to rule out red flags. There is good evidence that on examination clinicians cannot reliably differentiate specific anatomical structures but they should still perform a focused clinical examination to locate typical pain on movement and establish the neurological status. Base treatment on exercise, activity management and pain control.
Key Words: neck, examination, treatment, differential diagnosis.

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If your patient is presenting with symptoms of systemic disease, deteriorating neurological status or focal severe pain, initiate further investigations and or referral.
Once red flags have been ruled out, neck pain will fall into two categories: neurological or mechanical pain.
Range of Motion testing should be done in 3 specific planes; flexion-extension, lateral flexion and rotation. Moving the neck in circles does not provide useful clinical information.
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The Role of the Neurologic Examination in the Diagnosis and Categorization of Dementia

The Role of the Neurologic Examination in the Diagnosis and Categorization of Dementia

Teaser: 

John R. Wherrett, MD, FRCP(C), PhD, Professor Emeritus, Division of Neurology, University of Toronto; consultant in Neurology, Toronto Western Hospital and Toronto Rehabilitation Institute; member, Memory Clinic, Toronto Western Hospital, Toronto, ON.

Nonneurologist practitioners faced with the diagnosis of dementia cannot be expected to conduct the detailed assessments for which neurologists are trained. Nonetheless, they should be able to diagnose the most common forms of neurodegenerative dementia and identify individuals that require more detailed neurologic workup. A neurologic examination algorithm is described that allows the practitioner, in a stepwise and efficient manner, to elicit findings that distinguish the main categories of neurodegenerative and vascular dementia, namely, Alzheimer’s disease, dementia with Lewy bodies, vascular dementia, and frontotemporal lobar degenerations. Patients are assessed for gait, frontal signs, signs of parkinsonism, signs of focal or lateralized lesions, neuro-ophthalmologic signs, and signs characteristic of frontotemporal lobar degeneration.
Key words: neurologic, examination, neurodegenerative, dementia, diagnosis, gait, frontal dysfunction, cognitive impairment.