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.