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Wainner's Clinical Prediction Rule for Cervical Radiculopathy

Learn how to use Wainner's Clinical Prediction Rule to differentiate between cervical radiculopathy and other neck pain causes. In this video, we'll explain how to evaluate symptoms to reach a diagnosis and improve treatment for your patients.

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00:04 - 00:07This is running the Brooke Bush Institute in this video. We're going
00:07 - 00:11to go over the waner clinical prediction rule for cervical ridiculopathy. I'm
00:10 - 00:14gonna have my friend event come out. She's gonna help me demonstrate now,
00:13 - 00:16there's four tests in this
00:16 - 00:19cluster and I've done a video on each of
00:19 - 00:22those four tests where I go into the details on
00:22 - 00:25how to perform the test themselves. If you're looking for those details,
00:25 - 00:28please look for those videos in this video. We're gonna
00:28 - 00:31quickly kind of run through the cluster as I would go through
00:31 - 00:33it in clinic.
00:33 - 00:36Now the way this clinical prediction rule works is here's the
00:36 - 00:37four tests.
00:38 - 00:42Less than 60 degrees of cervical rotation spurlings.
00:43 - 00:46Compression test the distraction test and the
00:46 - 00:49Upper Limb tension tests, if you
00:49 - 00:53get two out of four, it's 56%
00:52 - 00:54specificity.
00:55 - 00:59Right. So that means you have 56% a
00:58 - 01:01chance of being right on your diagnosis. If
01:01 - 01:04you get two out of four, if you get three out of four that shoots
01:04 - 01:07up to 94% and then if you get four
01:07 - 01:09out of four shoots up to 99%
01:10 - 01:13Specificity all right. So we're
01:13 - 01:17talking about specificity which means if these are yeses, we're
01:16 - 01:19good. Unfortunately, even with this
01:19 - 01:22cluster sensitivity is still fairly
01:22 - 01:26low. So guys the nose on this cluster don't count
01:25 - 01:28for a whole lot. We can't
01:28 - 01:32use this cluster as a screen to for
01:31 - 01:34example ensure that
01:34 - 01:38somebody doesn't have cervical ridiculopathy.
01:39 - 01:42If we get a bunch of nose, we're still left with some guesswork.
01:43 - 01:46Now, what would this look like? Well, the first choice
01:46 - 01:50on this particular clinical prediction rule is a little interesting in
01:49 - 01:53the sense that cervical rotation goniometry
01:52 - 01:55is not particularly reliable. So
01:55 - 01:58if we're talking about me and how I would use it in clinic, I
01:58 - 02:01would look for obvious restriction and rotation and
02:01 - 02:04here's how I do it. I would probably stand facing a vet
02:04 - 02:07side and go hey that can you look at me which she
02:07 - 02:09is right now and I can tell you guys.
02:10 - 02:13Optimal rotation she should be able to get her chin
02:13 - 02:16over the top of her clavicle at the least that is
02:16 - 02:20some fairly marked restriction in
02:19 - 02:22rotation. I would Mark that as a
02:22 - 02:26positive. Now if you guys want to get the gyneometer out go for
02:25 - 02:29it. Just keep in the back of your mind ganiometry rotation
02:29 - 02:32for the cervical spine is not
02:32 - 02:35particularly reliable when it comes to it being a continuous
02:35 - 02:38interval measure. It's not very good at tracking
02:38 - 02:39how many degrees of change?
02:41 - 02:44Now the next test would be spurlings. If you
02:44 - 02:47guys remember that. This is just let's assume a vet
02:47 - 02:50has some symptoms here sitting with good posture.
02:51 - 02:54I'm gonna have her laterally Flex if that brings on more
02:54 - 02:55symptoms, that's a positive.
02:56 - 03:00If this didn't bring on more symptoms, but overpressure did
02:59 - 03:02here's how overpressure on spurlings. Look I'd
03:02 - 03:05have her laterally Flex then I go. Oh that didn't bring them on anymore.
03:05 - 03:06Okay, let me try this.
03:07 - 03:10And what I'm going to do is I'm gonna laterally Flex
03:10 - 03:13a little bit a little bit and compress
03:13 - 03:16a little bit and if that makes her symptoms worse,
03:16 - 03:18that's also a positive.
03:19 - 03:22Right. So we'll say that she was positive to that one too. Right?
03:22 - 03:25So she has marked decrease in rotation
03:25 - 03:28range of motion and she's positive for sperlings already.
03:28 - 03:28We should be gone.
03:29 - 03:30hmm
03:30 - 03:33It's looking pretty good that it's a ridiculopathy. We're
03:33 - 03:36already over 50% right fifty six percent. I'm going
03:36 - 03:38to go ahead and have her lay on her back now.
03:39 - 03:42The next test I'm going to do is the distraction test. Now the
03:42 - 03:45distraction test works if she had some symptoms here.
03:46 - 03:49but then when I put her into traction
03:51 - 03:54They went away. Does that feel better that feels a
03:54 - 03:56little better, right? That's a positive.
03:57 - 04:00All right. So if traction reduces her
04:00 - 04:03symptoms, that's a positive and you
04:03 - 04:06guys all I'm doing here is I wrapped this hand around the
04:06 - 04:09bottom of Ross put right. So if you guys find that that Ridge
04:09 - 04:12that's the new cool line. You just
04:12 - 04:16kind of go underneath it most of your forces from there. And
04:15 - 04:18then I kind of used a head cradle grip here
04:18 - 04:21pulled to the end of our throw kinematic range and that
04:21 - 04:24reduced her symptoms good that's a positive. The last
04:24 - 04:27thing I would do is my Upper Limb tension tests.
04:28 - 04:31and I'm just going to quickly go through them now guys
04:31 - 04:33if you want details on how to do these
04:35 - 04:38Slightly complicated tests. Please. Go back and find
04:38 - 04:39that video, but
04:41 - 04:41How does that feel?
04:42 - 04:42You're okay.
04:43 - 04:44Still okay good.
04:45 - 04:47And how about now?
04:47 - 04:48Yeah.
04:51 - 04:51Good.
04:52 - 04:55That's a little bit. Okay, let me have you
04:55 - 04:58laterally Flex for me not rotate. All right,
04:58 - 05:00so I need you to do this fly good.
05:01 - 05:04And let's try this one more time if that brought
05:04 - 05:07on symptoms faster. Yeah, there we go. Yeah that brought
05:07 - 05:09all symptoms faster. So that's a that's a positive.
05:10 - 05:13Right, but I'm not just gonna stick with maybe my media nerve. I might go ahead
05:13 - 05:16and also do alternative. I might
05:16 - 05:20do you can go ahead and go back to neutral things. I might
05:20 - 05:21do ulnar nerve.
05:22 - 05:25Right. I might do my radial nerve.
05:26 - 05:28And you guys once again can look up the video?
05:28 - 05:29for these tests
05:32 - 05:35to see how each one is performed. But the
05:35 - 05:38point for this cluster is is this
05:38 - 05:39is one more test.
05:40 - 05:43And we already have three positives if
05:43 - 05:46I also got a positive here, we'd be
05:46 - 05:49four out of four positives or specificity would be a 99% We
05:49 - 05:51can be fairly certain.
05:52 - 05:55That this is cervical ridiculopathy.
05:56 - 05:58All right. So let's review that one more time.
05:58 - 05:59All right, go ahead and sit up.
06:01 - 06:03Perfect. Thank you now.
06:04 - 06:07Rotation. Hey, so you you can
06:07 - 06:10do rotation on both sides if you want if you want to be really really thorough
06:10 - 06:13make sure that she has 60 degrees at
06:13 - 06:16least going in both directions. Can you look turn your
06:16 - 06:20head as far as you can? That's it. That's all you got. Sure. So
06:19 - 06:20bring on symptoms.
06:22 - 06:25A little bit. Okay. All right. So that's that's one. She definitely
06:25 - 06:28restricted like pretty significantly restricted going
06:28 - 06:31to the side. I could also test this side then we
06:31 - 06:34do sperlings. Hey, can I have you bend your head to the side cool?
06:35 - 06:38Over pressure if either of those brought on symptoms,
06:38 - 06:40that's a positive have her lie down.
06:42 - 06:44Right. She's feeling symptoms.
06:45 - 06:49Traction takes them away. That's
06:48 - 06:51a positive and of course
06:51 - 06:54if I get into these tests and she started testing positive
06:54 - 06:56man. We're four out of four.
06:57 - 06:57now
06:58 - 06:59go ahead and set up for me.
07:01 - 07:03if she's two out of four three out of four
07:05 - 07:08This is where you guys have to start using your judgment. You know
07:08 - 07:11one thing I've I've taught a lot recently. I feel like is
07:11 - 07:14everything we do is probabilistic, right?
07:14 - 07:17It all deals with chances and
07:17 - 07:20and likelihoods right? So if she's
07:20 - 07:23got two out of four positive signs, what
07:23 - 07:23are you gonna do?
07:24 - 07:27Well, you could do some other tests maybe for some
07:27 - 07:30other conditions that you might think is involved. You could
07:30 - 07:33try some therapy that you would normally use
07:33 - 07:36for a cervical ridiculopathy and see if that makes it
07:36 - 07:39better to try to help confirm your findings. Same thing
07:39 - 07:43if you got three out of four, well, hey, that's a 96% chance.
07:42 - 07:45We can be fairly certain a little
07:45 - 07:47less certain than we got four out of four.
07:48 - 07:51But you know start thinking about okay what other things could
07:51 - 07:53I do to help narrow?
07:55 - 07:56my intervention selection
07:57 - 08:00so that it is optimized for this
08:00 - 08:01particular patient.
08:02 - 08:05And in most cases guys unless we're dealing with the condition that is.
08:06 - 08:09For example surgical intervention is the
08:09 - 08:10most successful approach.
08:11 - 08:14Unless we're dealing with something like that. A lot
08:14 - 08:17of times. We're gonna get our diagnosis.
08:18 - 08:21That's going to help frame the model. We might use for
08:21 - 08:24intervention. And then what are we going to rely on
08:24 - 08:26after that? Well reassessment.
08:26 - 08:30Right and reassessment is going to include everything from maybe
08:29 - 08:32the tests that we got positives on
08:32 - 08:35to see if we've changed those to some of the subjective
08:35 - 08:38measures and outcome measures right to ensure that we're
08:38 - 08:42moving a vet back towards optimal function
08:41 - 08:44whatever she was doing before she came in with all these
08:44 - 08:44complaints.
08:45 - 08:46So there you guys have it.
08:47 - 08:49the Wainer clinical prediction rule
08:50 - 08:51three or four tests
08:52 - 08:55is really really high on specificity not great
08:55 - 08:58on sensitivity and the four tests
08:58 - 09:00are less than 60 degrees of rotation.
09:01 - 09:04Spurlings distraction and the
09:04 - 09:07Upper Limb tension tests. Make sure you look up each one of those videos
09:07 - 09:10individually and if you have any questions leave them in the comments box below.

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