Haben endgradige Tests an der HWS einen Einfluss auf die Hämodynamik hirnzuführender und (intra-)kranieller Gefäße?

Zusammenfassung

Physiotherapeut*innen werden häufig von Patient*innen mit Kopf- und Nackenbeschwerden konsultiert. Es besteht die Möglichkeit, dass sich hinter diesen Beschwerden vaskuläre Dysfunktionen verbergen. Die Herausforderung besteht daher, die geringe Zahl an Patient*innen ohne muskuloskelettale Ursache herauszufiltern und in die ärztliche Versorgung zu überweisen. Seit 2020 bietet die International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) eine aktualisierte Richtlinie für die Untersuchung und das Management von Patient*innen mit HWS-/Nackenbeschwerden, die potenziell ein vaskuläres Geschehen aufweisen. Dies soll Physiotherapeut*innen Sicherheit im Umgang mit diesen klinischen Fragestellungen geben und eine bestmögliche Entscheidung für das weitere Patientenmanagement ermöglichen.

Der Artikel stellt, vor dem Hintergrund mehrerer aktueller Forschungsartikel zur mechanischen Belastung des vaskulären Systems der zervikokranialen Region, die grundlegenden klinischen Muster arterieller Dysfunktionen der HWS dar und gibt einen Einblick, wie diese Beschwerden differenzialdiagnostisch eingeordnet werden können. Anhand eines Fallbeispiels wird das Wissen in den klinischen Alltag übertragen.

Abstract

Physiotherapists are often consulted by patients with head and neck complaints. There is a possibility that these complaints are caused by vascular dysfunctions. The challenge is to filter out the small number of patients without a musculoskeletal cause and refer them to medical care. In 2020, the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) presented updated guidelines for the examination and management of patients with cervical/neck complaints potentially due to a vascular event. The guidelines are intended to give physical therapists confidence in dealing with these clinical issues and to enable the best possible decision-making for further patient management.

Based on several recent research articles on mechanical loading of the cervical vascular system, this article presents basic clinical patterns of arterial dysfunctions of the cervical spine and provides insights into how these complaints can be diagnosed differentially. A case study transfers the knowledge to everyday clinical practice.

Schlüsselwörter

Hämodynamik - Halswirbelsäule - manuelle Untersuchung - Ultraschall - Positionstest - Validität - prämanipulative Tests - muskuloskelettale Therapie

Key words

hemodynamics - cervical spine - manual examination - ultrasound - positional testing - validity - premanipulative testing - musculoskeletal therapy

Publication History

Received: 29 August 2022

Accepted: 13 October 2022

Article published online:
19 July 2023

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