Cervical Artery Dissection, Loose Joint Syndrome and the Beighton Score
Written by: James Demetrious, DC, DABCO
Diplomate, American Board of Chiropractic Orthopedists
Diplomate, International Academy of Neuromusculoskeletal Medicine
Predispositions to Cervical Artery Dissection
Spontaneous cervical artery dissection (sCeAD) is rare. Highly powered research indicates that sCeAD is causally unrelated to chiropractic spinal manipulation.
Most patients do not suffer long-term adverse effects of sCeAD. Very few patients suffer the terrible consequences of this condition.
Patients, primary care physicians and specialists must identify and disclose information about cervical artery susceptibility for dissection with detailed reporting of related signs and symptoms.
With sufficient historical information, doctors may be able to diagnose and refer patients with developing sCeAD for emergent medical care.
Extraordinarily Difficult Diagnosis
The differential assessment and identification of developing sCeAD is extraordinarily difficult due to many factors:
- Rarity of the event,
- Most clinicians have never seen or recognized such cases,
- Poor disclosure of historic clinical events by prior attending physicians and patients,
- Unrecognized pre-existing acquired and heritable predispositions,
- Initial fleeting and often unrecognized clinical signs and symptoms of the initial developing event,
- No specific clinical examination that has high rates of confidence, with the exception of advanced imaging.
Some Insight
Mayo Clinic researchers, Keser et al., provide insight into pre-existing heritable predispositions of sCeAD. The authors indicate that 50–96% of sCeAD patients have subtle subclinical signs of underlying connective tissue disorder. [1]
Subtle signs of such undefined connective tissue disorders may be evidenced by joint hypermobility, multiple dislocations, joint sprains, easy bruising, thin/stretchy skin, and poor wound healing.
The assessment of joint hypermobility may provide clinical insight into identifying patients susceptible to sCeAD.
A Means to Assess Joint Hypermobility Syndrome
Joint hypermobility syndrome (JHS) is an associated attribute of recognized and unrecognized heritable connective tissue disorders. The Beighton Score (BS) is a simple and efficient means to assess for joint hypermobility.
The Beighton Score
The Ehlers-Danlos Society provides a simple, 5-part assessment of joint hypermobility. [2] While researchers are unclear about the validity of the BS, this assessment may provide some insight into JHS patients with susceptibility for sCeAD.
When utilizing the Beighton scoring system, there is no universal agreement related to the score threshold. While it may be imperfect, it is another data point for consideration.
Considerations and Conclusions
Nobody wishes to miss the opportunity to refer patients for emergency medical care of patients who present with developing sCeAD. Terrifying adverse events of sCeAD may include infarcts, stroke, locked-in syndrome, and death.
It is truly incumbent upon patients and medical providers to convey signs, symptoms, and known suspected pre-existing causes of connective tissue disorders that are heritable and acquired.
The assessment of the joint hypermobility may provide some insight into sCeAD susceptibility. It takes less than 60 seconds to perform and may save a life.
References
2.) The Ehlers-Danlos Society. Accessed on September 30, 2023.
For advanced CE, go to PostGradDC.com.
PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. Register for coursework at PostGradDC.com.
