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Evaluating Soft-Tissue Neck Trauma

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Evaluating Soft-Tissue Neck Trauma

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After neck injury, a careful neurologic evaluation must be conducted, and every examination should begin with a thorough case history. (See Table 1). Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg s sign should be conducted, along with superficial and tendon reflex tests.

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  1. Gallatin Valley Chiro February 26, 2010 at 10:50 am

    Very good post. I always make sure to do the VBI test as well to rule out any vertebral artery problems or complications. A full cranial nerve test doesn’t take long either and is always good to confirm and rule out nerve injury. X-rays are a useful diagnostic tool as well but more so for determining fractures and dislocations. MRI can be expensive, but is a very useful imaging tool and helps with both bone and soft tissue diagnoses.

  2. nene February 28, 2010 at 8:55 am

    Gallatin posts:
    >>”Very good post. I always make sure to do the VBI test as well to rule out any vertebral artery problems or complications.”<<

    May I ask 'Why' do you VBI(Georges) test?


    "For many years it was thought that George's Test was a viable testing procedure to help screen for patients who may be at greater risk for vertebral artery dissection following cervical spine adjusting. The fullness of time and the advancing accumulation of literature have changed that perspective and today the perspective on the test is that its use has the potential to cause more harm than good,.

    In March 2004, the Clinic Directors of all the chiropractic schools and programs in the United States recommended to the presidents and/or deans of the institutions and program that they support a move to discontinue the use of George's Test and similar provocative testing in this setting. This position was supported by the presidents and deans………."

    Also see:

  3. Frank February 28, 2010 at 3:13 pm


    Excellent point. The mechanism of injury most associated with vertebral artery damage is a combination of rotation and extension.

    We are taught NOT to extend the spine while doing rotary (diversified) adjusting.

    That’s also what most appealed to me about Gonstead and Pierce (Pierce/Stillwagon) adjusting, since they are all P-A with no rotation at all.

  4. nene March 2, 2010 at 8:11 am

    Actually, my main point was to address the claim of: >>”I always make sure to do the VBI test as well to rule out any vertebral artery problems or complications.”<<

    The "VBI test"(George's test) is clinically irrelevant. It is not supported by science. It does not "rule out any vertebral artery problems or complications" The ONLY reason to do this meaningless test is to meet a legal standard —-not clinical standards of care.

  5. Frank March 2, 2010 at 1:31 pm


    This may be new information to you, but it’s old news to my profession.

    I’m curious what your interest is?

    Have you reviewed the Stroke page?

  6. nene March 2, 2010 at 2:04 pm

    Frank- indeed it is old information and therefore I was a bit flumoxed when Gallitan posted: “I always make sure to do the VBI test as well to rule out any vertebral artery problems or complications.” Current evidence clearly does not support this claim.

  7. I know that they are still teaching this test in schools around the country, and there is a reason for it. The test applies only gentle pressure and is aimed to identify initial arterial problems. If this simple test can cause a VBI, then you would have to agree that looking over your shoulder while backing out of the clinic parking lot could as well? If so, then wouldn’t you rather this patient be in the hands of a health care professional who can correctly diagnose and take appropriate action for the situation instead of the patient being somewhere else. A positive test is interpreted as a sign to avoid further manipulation and to seek further attention to the problem.
    The point is, if this test is going to cause damage to the vertebral artery, than most any activity involving these day to day movements involving extension and rotation would have the same outcome. If so, and we are talking about clinical relevance and not legal standards, then I would rather be able to identify the problem myself instead of my patient being on their own and not knowing how to handle the situation.

  8. seattle chiropractor November 8, 2010 at 11:06 am

    There are no tests that will identify a patient at risk for VAD. I wish there were.

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