Academy of Chiropractic’s Lawyers PI Program

Clinical Information #4

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

“Cervical Arterial Insufficiency Orthopedic Testing”

Chiropractic is SAFE… There are zero side effects regardless of the informed consents required by both your malpractice carriers and the individual state boards in healthy individuals. The research has proven that...


Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified (Whedon et al., 2015, p. 5) 


Reference: 

Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

The caveat is that there are patients who could need drugs or surgery and an accurate diagnosis is paramount. It is incumbent upon the doctor of chiropractic to be fully trained in both the diagnostic and treatment facets of care. It is also important that the chiropractor be well-versed in MRI protocols and interpretation as well as disc pathology in order to be able to triage the patient accordingly based upon the clinical presentation inclusive of the MRI results.

As a result, part of your examination should include vertebral artery compression testing in conjunction with your standard evaluation. Patients suffering from cervical carotid aneurysms often experience neck pain prior to the dissection. It is a rare occurrence for a chiropractic patient to experience dissecting aneurysms as sequella to a chiropractic adjustment and significantly more patients experience this phenomena after a visit to their primary care physician according to the research because these patients experience problems and usually seek their care first. 

Reference: http://stroke.ahajournals.org/content/10/2/144.full.pdf

ANEURYSMS of the carotid artery in the neck are an uncommon disorder, but not rare. Although the most frequent presenting complaint in patients with these lesions is an uncomfortable mass in the neck, the clinical picture may be quite variegated. Head- ache, neck and facial pains, subjectively audible bruits, hoarseness, upper airway obstruction, dysphagia, hemoptysis, and epistaxis, have all been reported as initial symptoms of these lesions. Neurological symptoms are also not uncommon as initial presentations. 

Although it is a rare occurrence in the chiropractic office, we should still, as a matter of practice perform the cervical orthopedic testing for arterial insufficiency in every patient you will be adjusting their cervical spine. The following tests should be considered:

Note: These 2 slides were taken from the orthopedic testing course to be released within the next 2 months