Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 26
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30Table 5. Signs and symptoms indicative of pathologies amenable to sole PT management.
•
Intermittent, severe positioning-type dizziness
Benign paroxysmal
•
Precipitated by positioning, movement, or other stimuli (see below)
positional vertigo
•
Short latency: 1-5 seconds
(BPPV)
•
Brief duration: < 30 seconds
•
Fatigable with repeated motion
•
Associated signs and symptoms: nystagmus, nausea, and at times vomiting
•
Occurs in people over age 40 with peak incidence of onset in the sixth decade
•
Rare in people under 20
•
Medical history of head trauma, labyrinthine infection, surgical stapedectomy,
chronic suppurative otitis media, and degenerative changes to the inner ear may
indicate non-idiopathic BPPV.
•
Patients complain of dizziness when they quickly transfer to a supine position,
Posterior
especially when the head is turned to the affected side.
semicircular canal
•
Positive response of vertigo and apogeotropic torsional nystagmus on ipsilateral
(SCC) BPPV
Hallpike-Dix maneuver
•
Patients also complain of dizziness when they quickly transfer to a supine
Anterior SCC
position, especially when the head is turned to the affected side, but there is
BPPV
less specifi city as to the direction of head rotation.
•
Bilateral positive response on Hallpike-Dix maneuver with vertigo and geotropic
torsional nystagmus on ipsilateral test
•
Hallpike-Dix maneuver may also cause downbeating vertical nystagmus.
•
Positive response on straight head-hanging test
•
Dizziness is brought on when rolling over in supine but can also occur with
Horizontal SCC
fl exion and extension of the head or when transferring from supine to upright.
BPPV
•
A bilaterally positive test with a purely horizontal nystagmus on Hallpike-Dix
maneuver. The nystagmus will be geotropic beating in the direction of the face
turn or downside ear. Nystagmus will occur in both directions but is generally
stronger when the head is turned towards the affected side.
•
Positive roll test
•
Positive walk-rotate-walk test to affected side
•
Intermittent positioning-type dizziness
Cervicogenic
•
Precipitated by head and neck movement
dizziness
•
No latency period: onset of symptoms is immediate upon assuming the
provoking position
•
Brief duration but may last minutes to hours
•
Fatigable with repeated motion
•
Associated signs and symptoms: nystagmus, neck pain, suboccipital head-
aches, sometimes paraesthesiae in the trigeminal nerve distribution
•
Possible lateral head tilt due to tightness of the sternocleidomastoid or upper
trapezius
•
Possible forward head posture
•
Medical history of cervical spine trauma and degeneration
•
Motion dysfunction in the upper cervical segments on AROM and PIVM testing
•
Positive neck torsion test: nystagmus with reproduction of dizziness
•
Subjective complaints of weakness, unsteadiness
Musculoskeletal
•
Insidious onset
impairments
•
Postural deviations negatively affecting the location of the center of gravity in
relation to the base of support: trunk fl exion, hip fl exion, knee fl exion, and ankle
plantar fl exion contractures
•
Decreased trunk extension, hip extension, knee extension, and ankle
dorsifl exion on ROM testing
•
Loss of strength and endurance in anti-gravity muscles
•
Impaired joint position sense lower extremity
Dizziness in Orthopaedic Physical Therapy Practice:
History and Physical Examination / 247
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