Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination (Page 6 of 30) in pdf

Paget’s disease, diabetes mellitus, hypothyroidism, and in

criteria for cervicogenic dizziness

. A unilateral pulsatile

50% of patients treated with the chemotherapeutic drug

headache may be indicative of migraine

. A sudden-on-

. Any previously undiagnosed complaint

set neck and occipital pain is the hallmark symptom of

Cis-platinum

10,19

of hearing loss (especially when confirmed by physical

vertebral artery dissection

. Occipital headache is a

14,27

tests) indicates a need for referral.

symptom of vertebrobasilar migraine

. Chest, neck, and

arm pain or discomfort may be symptoms implicating

Tinnitus

a cardiovascular etiology for patients complaining of

Tinnitus may occur in patients with Meniere’s disease

presyncopal dizziness

. Chest pain may also occur in

as does a feeling of fullness of the ear

. Tinnitus

patients with panic disorder

. Paroxysmal pain in the

10,12,19

23,24

also occurs in patients with Cis-platinum and salicy-

tonsillar pillar or external ear with swallowing, talking,

late toxicity and in patients with familial paroxysmal

or coughing implicates glossopharyngeal neuralgia as a

ataxia

. Tinnitus can also be more benign, resulting

cause for presyncopal dizziness

. Variable patterns of

10,11

10,19

from increased tone in the tensor tympani muscle due

arm, leg, and trunk pain can be a symptom in patients

to trigeminal hyperactivity associated with an upper

with myelopathy

. Abdominal pain may occur due to

15-17

cervical injury

. A complaint of tinnitus combined

quinine or quinidine toxicity

. In the context of evaluat-

with aural fullness, or a positive medication history, or

ing patients with dizziness, any pain pattern other than

a family history positive for familial paroxysmal ataxia

those indicative of cervicogenic dizziness-related neck

indicates a need for referral.

pain and musculoskeletal pain possibly associated with

musculoskeletal impairments causing dysequilibrium

Nausea

indicates a need for referral.

Nausea is common in patients with BPPV, Meniere’s

Sensory Abnormalities

disease, acute peripheral vestibulopathy, salicylate overdos-

age, quinine or quinidine overdosage, cerebellar tumors,

Peri-oral numbness and paraesthesiae are a symp-

Arnold-Chiari malformation, migraine, or VBI

. It

tom in patients with hyperventilation but also occur

10,12,13,22

can also be indicative of panic disorder

. A positive

in patients with VBI

. Limb paraesthesiae are also a

23,24

10,13

family history for Meniere’s disease or a positive medi-

symptom for patients with vertebrobasilar migraine

cation history in combination with nausea indicates a

Bilateral or quadrilateral limb paraesthesiae, either

likely need for referral.

constant or reproduced or aggravated by neck move-

ments may indicate VBI

. Arm paraesthesiae are com-

Vomiting

mon in patients with subclavian steal syndrome

Vomiting may be a symptom for patients with Me-

Non-dermatomal sensory impairments are indicative

niere’s disease, acute peripheral vestibulopathy, salicylate

of myelopathy

. Peripheral neuropathy in the lower

15-17

overdosage, quinine or quinidine overdosage, cerebellar

extremities commonly occurs in the diabetic popula-

tumors, Arnold-Chiari malformation, and vertebrobasilar

tion, resulting in impaired somatosensory function

migraine

. The occurrence of vomiting in patients

Paraesthesiae in the trigeminal nerve distribution may

10-12

with BPPV is rare

. Vomiting, headache, ataxia, and

occur with cervicogenic dizziness, indicating involve-

22,25

visual dysfunction are often the presenting symptoms

ment of the trigemino-cervical nucleus

. Trigeminal

in children with primary cerebellar tumors and a clear

distribution (facial) and non-dermatomal patterns of

indication for referral

. A complaint of vomiting with

paraesthesiae indicate the need for careful evaluation

dizziness may indicate a need to refer in adults and

and possible referral.

constitutes a clear reason for referral in children.

Strength and Endurance

Dysarthria

Facial weakness is a symptom in patients with

Dysarthria can be a symptom in patients with hy-

cerebellopontine angle tumor and familial paroxysmal

pothyroidism, paraneoplastic cerebellar degeneration,

ataxia

. General fatigue occurs in patients with diabetes

10,11

Friedreich’s ataxia, ataxia-telangiectasia, Creutzfeldt-

or cardiovascular etiologies for presyncopal dizziness

Jakob disease, familial paroxysmal ataxia, VBI, and

complaints

. Chronic fatigue is also a symptom of panic

28,32

vertebrobasilar migraine

. A complaint of dysarthria

disorder

. Transient quadriplegia is a rare symptom

10,11,13

23,24

indicates the need for referral.

in patients with vertebrobasilar migraine

. Ipsilateral

arm fatigue or even paresis is indicative of subclavian

Pain

steal syndrome

. Non-myotomal weakness in legs and

Headache is a symptom in patients with cerebellopon-

arms may indicate myelopathy; generally, complaints of

tine angle and cerebellar tumors, salicylate overdosage,

weakness may focus the clinician on a musculoskeletal

Arnold-Chiari malformation, familial paroxysmal ataxia,

impairment as causative or contributory to the patient’s

and cervicogenic dizziness

. In fact, a correlation

complaint of dizziness or dysequilibrium. Any weak-

10,11,26

between neck pain and dizziness is one of the diagnostic

ness not directly related to a discrete musculoskeletal

Dizziness in Orthopaedic Physical Therapy Practice:

History and Physical Examination / 227

Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 6

Related Articles

Related Categories