Cervical arterial dysfunction (CAD) is an umbrella term for rare vascular problems of the neck. There are a range of blood vessels in the body that transport blood to different regions. In relation to cervical arterial dysfunction, this presentation can start from varied sources. An acute injury, such as neck trauma from a road traffic collision or impact from a rugby tackle, can cause trauma to the blood vessels. As a result, this can cause damage to the vessel itself, restricting blood flow or the opposite where blood flow is increased (1).
Non-traumatic presentations are usually linked to comorbidities (other conditions) and it is important to note that rarely is this a single causal factor but more multi-factorial in nature (1). What this means is that patients who are more at risk would have previous vascular medical history, such as a long history of smoking or high blood pressure, that could contribute to having cervical arterial dysfunction (1,2,3).
We ensure that regular training with our therapists is carried out so we can recognise patients presenting with cervical arterial dysfunction and refer them through the correct treatment pathway.
There can be varied signs and symptoms which are categorised into early and late.
Early – acute neck pain can be severe, headache, tenderness of the jaw, difficulty in chewing or tongue pain. Increase in blood pressure and awareness that you simply just do not feel right. May have weird, worsening reaction to treatment such as massage or manipulation from a therapist (3).
Late – Worsening neck pain, feeling hot and blood pressure is increased. Retinal dysfunction such as blurred vision, double vision or dizziness, facial numbness, vomiting, speech and swallowing difficulty, sudden blindness, tinnitus. At worst, you may suffer a stroke (3).
This is not an exhaustive list. These factors could increase the likelihood of someone developing cervical arterial dysfunction. It does not mean everyone with these risk factors will develop symptoms (2, 5).
The prevalence of cervical arterial dysfunction is low and the incidence of the disease is relatively low in the general population, estimated at around 2.6-3 out of 100,000 individuals per year (1). It can affect all age groups – internal carotid artery dissection is more common in those between the ages 34-54 and vertebral artery dissection in those over the age of 55 (1).
As with every type of problem, a detailed subjective (verbal questioning) and objective assessment (physical tests) will be carried out with your GP or physiotherapist. With cervical arterial dysfunction, there are subjective questions that will allow the clinician to assess the risk of you having or developing cervical arterial dysfunction. If there is any suspicion you will be sent to the hospital for further investigations which are:
It is important to know that diagnosis and early treatment are vital to avoid any more serious events such as a stroke.
Once cervical artery dysfunction has been diagnosed and addressed, self-management is vital for preventing any reoccurrence. It is important to note that lifestyle changes made should be long-term. This can be giving up smoking, losing weight or just simply being more active in your lifestyle. Physiotherapists are best suited to advise and help you with this and can also refer you to various other professionals to help make these important changes.
Below are three programmes of exercises that are aimed at assisting with the overall management of your condition. Although they will not always cure the condition, research tells us that activity of this nature will be helpful in minimising the effect of the condition.
These exercises focus on the basic range of motion of the neck. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.
For patients wanting to achieve a high level of function or return to sport, an assessment will be made by the physiotherapist to check your strength, range of movement, stability and general functional capacity to be safe enough for a return to sport. Before returning to sport, a rehabilitation programme should ideally incorporate some contact drills and exercises that mimic the sport you participate in.
As part of a comprehensive treatment approach, your physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
Medical treatments usually work well so surgery is only considered in very exceptional circumstances. If, for example, you cannot take anticoagulant or antiplatelet medicines or medicines are not working for you, your doctor may suggest an angioplasty and stenting procedure to help prevent blood clots forming.
An angioplasty involves putting a balloon into a narrow or blocked artery to widen it. A stent is a mesh tube inserted into the artery so that blood can still flow through it easily once the balloon has been removed. Other surgical procedures are possible, but again are only considered necessary on very rare occasions (6).
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
With PCN partnerships from Cornwall to Durham, Weston-Super-Mare to Southwold, our network of specialist physiotherapists operate face-to-face or remotely depending on your local needs.
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