15/06/2025
Screening the carotid arteries prior to cervical manipulation is critically important for ensuring patient safety. Here's why it matters:
1. Risk of Stroke or Transient Ischemic Attack (TIA)
The carotid arteries supply a major portion of the brain’s blood flow.
Atherosclerotic plaques or other abnormalities in the carotids can make them prone to embolisation or rupture if disturbed.
Cervical manipulation, especially high-velocity, low-amplitude (HVLA) thrusts, can potentially dislodge plaques, leading to ischemic stroke or TIA.
2. Detection of Carotid Artery Disease
Carotid artery stenosis (narrowing) is often asymptomatic until serious events like stroke occur.
Screening can identify:
Bruits (abnormal sounds)
Reduced or absent pulses
History of vascular disease
High-risk factors (e.g., hypertension, diabetes, smoking, advanced age)
Early identification allows for medical referral and appropriate management before manipulation is considered.
3. Vertebral Artery vs. Carotid Artery Concerns
While much focus is placed on vertebral artery dissection in cervical manipulation risk, carotid artery disease poses a significant threat in older populations or those with vascular risk factors.
Screening helps differentiate between risks related to vertebral artery dissection (often younger patients) and carotid artery disease (typically older with atherosclerosis).
4. Medico-legal and Ethical Responsibility
Failing to screen can lead to serious legal implications if an adverse event occurs.
Practitioners have an ethical duty to minimize risk and practice in accordance with evidence-based guidelines.
5. Guideline Recommendations
Several professional organizations recommend pre-manipulative vascular screening, particularly in at-risk populations.
Where indicated, non-invasive imaging (e.g., carotid ultrasound) may be warranted prior to manipulation.
⚠️ Summary
Screening the carotid arteries before cervical manipulation:
Protects against potentially catastrophic vascular events like stroke.
Helps identify patients who may require referral for vascular assessment.
Fulfills ethical and professional obligations to ensure patient safety.
Would you like to learn how to perform carotid artery screening?
Handheld Diagnostic MSK Ultrasound - Diagnostic Power in Your Hands
📅 12–14 September 2025
📍 British College of Osteopathic Medicine (BCOM) 6 Netherhall Gardens, London NW3 5RR
🕒 3-Day CPD (21 Hours)
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Learn CPD Handheld Diagnostic Musculoskeletal Ultrasound to improve patient management and streamlined clinical decisions
