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Codifying upper cervical instability with Leslie Russek, DPT, PhD

Upper cervical instability (UCI) occurs quite commonly in the mild form and more rarely in the

severe form in those with symptomatic generalized joint hypermobility (S-GJH). Both can be impactful and are frequently missed. An international team of physical/physiotherapy clinicians and a S-GJH expert rheumatologist recently published expert consensus recommendations for screening, assessing and managing patients with UCI associated with S-GJH. Bendy Bodies sat down with first author, Leslie Russek, DPT, PhD, to discuss this important paper.

Hypermobility (too much range of motion) is different from instability (difficulty controlling motion at the joints). UCI, upper cervical instability, means that the muscles and nerves lack the ability to appropriately control movement at the joint and sense where the joint is in space. When UCI is severe it can be debilitating. Except in the most extreme forms of UCI, conservative (ie: non-surgical) therapies are usually considered first. Improving joint stability is the goal and Dr. Russek explains what patient factors are important to consider in determining treatment strategy.

Dr. Russek explains the difference between “highly suggestive” and “common” symptoms as well as musculoskeletal UCI vs neurological UCI. She describes the three levels of irritability and how those should be approached in clinical practice. Yellow and red flags in the history and the physical examination are addressed.

Whether you are someone who suspects upper cervical instability or treats them, this is an episode you will not want to miss.

Learn more here.

This article, “Presentation and physical therapy management of upper cervical instability in patients with symptomatic generalized joint hypermobility: International expert consensus recommendations”, is a must-read for anyone treating this complex population.

Check out these recent articles on imaging studies and surgical management of UCI in S-GJH.

Mao G, Kopparapu S, Jin Y, Davidar A, Hersh A, Weber-Levine C, et al. Craniocervical instability in patients with Ehlers-Danlos syndrome: controversies in

diagnosis and management. Spine J. (2022) 22:1944–52. doi: 10.1016/j.spinee.2022.08.008

Lohkamp L, Marathe N, Fehlings M. Craniocervical instability in Ehlers-Danlos syndrome-A systematic review of diagnostic and surgical treatment criteria. Global Spine J. (2022) 12:1862–71. doi: 10.1177/21925682211068520

Marathe N, Lohkamp L, Fehlings M. Spinal manifestations of Ehlers-Danlos syndrome: a scoping review. J Neurosurg Spine. (2022) 37:783–93. doi: 10.3171/2022.6. SPINE211011

Michel C, Dijanic C, Abdelmalek G, Sudah S, Kerrigan D, Yalamanchili P. Upper cervical spine instability systematic review: a bibliometric analysis of the 100 most

influential publications. J Spine Surg. (2022) 8:266–75. doi: 10.21037/jss-21-132

"UCI in S-GJH has been the topic of several recent publications discussing imaging studies and surgical management. This recent literature asserts that UCI in S-GJH is an important condition to recognize, and there is a need for consensus-based recommendations, practice guidelines and care pathways for patients (2, 5, 6,12)."


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