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| LETTERS TO EDITOR |
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| Year : 2019 | Volume
: 63
| Issue : 7 | Page : 602-603 |
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A simple assessment of cervical range of motion, using indigenous technique (modified analog clinometer)
Masoud Nashibi1, Kamran Mottaghi1, Zahid Hussain Khan2
1 Department of Anesthesiology and Critical Care, Shahid Beheshti University of Medical Sciences, Loghman Hakim Hospital, Tehran, Iran
2 Department of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Imam Khomeini Complex, Tehran, Iran
| Date of Web Publication | 12-Jul-2019 |
Correspondence Address:
Prof. Zahid Hussain Khan
Departments of Anesthesiology and Critical Care, Tehran University of Medical Sciences, Imam Khomeini Complex, Tehran
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ija.IJA_154_19
How to cite this article:
Nashibi M, Mottaghi K, Khan ZH. A simple assessment of cervical range of motion, using indigenous technique (modified analog clinometer). Indian J Anaesth 2019;63:602-3 |
How to cite this URL:
Nashibi M, Mottaghi K, Khan ZH. A simple assessment of cervical range of motion, using indigenous technique (modified analog clinometer). Indian J Anaesth [serial online] 2019 [cited 2021 Apr 22];63:602-3. Available from: https://www.ijaweb.org/text.asp?2019/63/7/602/262607 |
Sir,
If we have an inquisitive and critical look at the contemporary literature, we will find different gadgets and appliances have been used to assess the cervical range of motion (CROM),[1],[2],[3] in patients before laryngoscopy and intubation is executed. However, each of these gadgets is either cumbersome, costly and thus difficult to employ practically, such as X-ray assessment[4] or of moderate accuracy using goniometer.[5] In the assessment of airway, CROM is important because the lack of CROM is associated with difficult laryngoscopy, intubation and even bag-valve-mask (BVM) ventilation. In order to correctly measure CROM, we have used an indigenous inexpensive appliance called analog clinometer. The device instantaneously provides with the correct measurements of CROM in the neutral, full extension and full flexion views.
This metallic non-expensive device (10$ to 35$ USD) is primarily designed to be used by architects to assess slopes. We have modified it by adding a disposable wooden spatula so it can be used in the assessment of neck flexion and extension range – by putting the spatula between molar teeth or between gums in edentulous patients. Even in limited mouth opening, this device can be utilised properly, as the attached wooden spatula needs just a tiny space equal to 2 to 3 mm to be advanced between molar teeth. However, it has limited utility among small children, non-cooperative patients and patients who have arch bars on their teeth.
The clinometer has a semicircle scale from -90°to +90° and a movable marker attached to a bubble containing small transparent cylinder. When the clinometer is put on a slope, by moving the marker, the user adjusts the cylinder to keep the bubble in the middle, so the marker will point the exact degree of that slope [Figure 1]. Since it is made of metal and plastic, environmental variables such as barometric pressure, temperature and humidity cannot affect its performance. We used GEO-ALLEN/OEM YR-27 made in China clinometer. [Figure 2] depicts the clinometer with an attached dental spatula placed between the last upper and lower molars with the patient in neutral position. [Figure 3] reflects the patient in full extension, the bubble reveals an angle of 72° and full flexion, an angle of 58°, respectively. The sum of the angles in extension and flexion gives us a figure of 130°, reflecting that the CROM is adequate for laryngoscopy and intubation. | Figure 1: Shows how a clinometer is utilised to measure the degree of a slope
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 | Figure 2: A spatula attached to the analog clinometer and then modified analog clinometer placed between the upper and lower last molars in the neutral position, with the mouth fully closed
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 | Figure 3: The patient in a full extension and flexion of the neck and the modified analog clinometer showing angles of 72° and 58°, respectively
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Compared to the other appliances mentioned above, our new indigenous technique helps in measuring the CROM within less than a minute with a high degree of accuracy and low cost. However, in order to test its true validity and reliability, the device should be tested with the other currently available tools for the assessment of CROM.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Mangone M, Bernetti A, Germanotta M, Di Sipio E, Razzano C, Ioppolo F, et al. Reliability of the cervical spine device for the assessment of cervical spine range of motion in asymptomatic participants. J Manipulative Physiol Ther 2018;41:342-9.  |
| 2. | Moreno AJ, Utrilla G, Marin J, Marin JJ, Sanchez-Valverde MB, Royo AC. Cervical spine assessment using passive and active mobilization recorded through an optical motion capture. J Chiropr Med 2018;17:167-81. |
| 3. | Whitcroft KL, Massouh L, Amirfeyz R, Bannister G. Comparison of methods of measuring active cervical range of motion. Spine 2010;35:E976-80. |
| 4. | Machino M, Yukawa Y, Imagama S, Ito K, Katayama Y, Matsumoto T, et al. Age-related and degenerative changes in the osseous anatomy, alignment, and range of motion of the cervical spine: A comparative study of radiographic data from 1016 patients with cervical spondylotic myelopathy and 1230 asymptomatic subjects. Spine 2016;41:476-82. |
| 5. | Chaves T, Nagamine H, Belli J, de Hannai M, Bevilaqua-Grossi D, de Oliveira A. Confiabilidade da fleximetria e goniometria na avaliação da amplitude de movimento cervical em crianças. Braz J Phys Ther 2008;12:283-9. |
[Figure 1], [Figure 2], [Figure 3]
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