• Cervicogenic PCS

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Purpose:  In the context of Post Concussive Symptoms, cervicogenic components need to be addressed in this case. The goal is to recreate headaches, dizziness, and/or dysfunctional patterns that may be causing symptoms. The key to differential diagnosis of cervicogenic concussion symptoms is testing if cervical afferents cause symptoms or disruptions in balance and oculomotor control. This is not a standard orthopedic examination of the cervical spine.

  • Sense of Unsteadiness*
  • Sense of Dizziness*
  • Sense of “Feeling Off”*

  • Vision Related Symptoms

  • Visual Fatigue*
  • Sensitivity to Light*
  • Blurred Vision*
  • Difficulty Reading*
  • Words Move on Page*

  • Clinical Examination

  • Trigger Points:  Trigger points (TPs) are not simply indurations or muscle knots. When adequately stimulated, TPs exhibit referred pain phenomenon and often autonomic phenomena. TPs can be latent or active.   Cervical Referral Patterns for Headaches were assessed via the following trigger point regions:

  • Splenius Capitis (refers to top of head)*
  • Suboccipitals (refers to temporal region)*
  • SCM (refers supraorbital, vertex, auricular)*
  • Superior Trap (refers suboccipital and temporal)*
  • Semispinalis Capitis (refers in hatband)*
  • Occipitalis (refers posterior head / retro-orbital)*
  • Longus Coli (refers occipital/auricular regions)*
  • Cervical Facet Joints:  Deep palpation of the cervical facet columns revealed:*

  • Cervicogenic Dizziness

  • Notation:  Cervicogenic dizziness is generally not true vertigo (the room does not spin and there is no nystagmus). These patient's generally "just feel off". They have greater difficulty with extension but generally don't have problems lying supine. Cervicogenic vertigo patients were more likely to report that their symptoms increased with looking up and reporting that quick movements of their head increased their symptoms vs. other forms of dizziness (Reid et al. 2017).

  • Cervical Extension: Elicit Dizziness?*
  • Rotatory Chair Test*
  • Cervical Flexion / Rotation*

  • Sensorimotor Impairment

  • Notation: There are three pillars of Sensorimotor Impairment:

    • Proprioception
    • Oculomotor Control
    • Postural Stability

    There are tremendous neurological connections between cervical muscle spindles and eyes (Cervico-Ocular Reflex = COR) and vestibular apparatus and eyes (Vestibulo-Ocular Reflex = VOR). These are the fastest reflexes in the body telling the eyes to move at exactly the same rate as the neck when turning the head. If one of these mechanisms is off -- the patient will "feel off".

  • Proprioception:

  • Cervical Joint Position Error Test (JPET) *
    Rows

  • Oculomotor:

  • Smooth Pursuit Neck Torsion Test (SPNTT)Cervical Facet Joints:  Deep palpation of the cervical facet columns revealed:*

  • Near Point Convergence Neck Torsion Test
    Neutral:   *   cm
    Right Rotation   *   cm
    Left Rotation:   *   cm

  • Postural Stability:  

  • Tandem Stand (eyes closed)*
  • Head Turns (walking)*

  • DIAGNOSES (ICD-10)

  • Concussion W/O LOC (Subsequent Visit)*
  • Concussion W/ LOC < 30 Min (Subsequent Visit)*
  • Concussion W/ LOC Unspecified Duration (Subsequent Visit)*
  • Persistent Concussive Symptoms (PCS)AKA Post Concussion Syndrome*
  • Convergence Insufficiency*
  • Dizziness*
  • BPPV*

  • PLAN / RECOMMENDATIONS

  • Cervicogenic PCS Testing*
  • Cervicogenic Rehab Prescribed: When prescribed, each exercise is reviewed with the patient in detail. The patient is also given a detailed instruction handout. It is important the patient performs the exercises 3-4x/day. The patient indicated any understanding.*
  • Schedule:*
  • Neurocognitive Testing Reviewed*
  • Neurologic Co-Management Reviewed*
  • Psychological Complicating Factors Present*

  • Time: Today, I spent   *  minutes reviewing the patient’s current status, outcome measures, performing a Cervicogenic PCS evaluation, discussing my recommendations, documenting my findings and completing the chart note. The patient indicated an understanding of our discussion and we will implement the above treatment plan.

  • Tests Reviewed*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

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