Assessment and subgrouping

This section focuses on how to assess possible cervical arterial dysfunction in clinical practice, especially in the patients most commonly seen with musculoskeletal neck pain. It introduces a subgrouping model to help clinicians judge risk, with particular attention to lower-risk Class 1 and Class 2 presentations, while recognising when more serious signs may point to higher-risk groups. Key assessment themes include vascular risk factors, such as smoking, hypertension, infection, diabetes, migraine history, and relevant medications. It also explains the importance of keeping arterial dysfunction in mind when the patient’s presentation does not fit a clear musculoskeletal explanation. Practical examination priorities are outlined, especially blood pressure measurement and cranial nerve testing, replacing older reliance on positional vertebrobasilar tests. A major emphasis is placed on clinical reasoning and the order of examination. When suspicion is high, blood pressure and cranial nerve assessment may need to come before movement-based or manual testing. The session also highlights the broader role of physiotherapists in screening cardiovascular health, discussing lifestyle factors, and using findings to guide referral, urgent action, or ongoing management.