Chiropractic Clinical Sciences and Diagnosis
This domain tests whether you can turn a patient’s history and examination into a defensible diagnosis. Expect questions on interview technique, regional and neurological examination, orthopedic tests, imaging appropriateness, red flags, differential diagnosis, and chart documentation.
Core rules
- Start with the chief complaint and characterize it with location, quality, severity, timing, aggravating and relieving factors, and associated symptoms.
- Screen for red flags before treatment: fever, unexplained weight loss, night pain, history of cancer, intravenous drug use, bowel or bladder dysfunction, saddle anesthesia, progressive motor deficit, and significant trauma.
- Localize neurological findings by dermatome, myotome, and reflex. A reflex change is a useful localizing sign but not a stand-alone diagnosis.
- Use orthopedic tests as supplements, not substitutes: straight-leg raise for lumbosacral root irritation, Spurling for cervical radiculopathy, FABER for hip or sacroiliac pathology.
- Do not routinely image uncomplicated mechanical low back pain. Reserve MRI for suspected infection, tumor, cauda equina, cord compression, or persistent radiculopathy before intervention.
- Record positive and pertinent negative findings; document consent and the rationale for tests ordered.
Worked example
A 52-year-old man reports three weeks of low back pain radiating down the posterior thigh and lateral foot. Achilles reflex is diminished, plantar flexion is weak, and straight-leg raise reproduces leg pain at 35 degrees. He has no bowel or bladder change, fever, cancer history, or progressive weakness. The dermatome, myotome, and reflex localize to S1; positive straight-leg raise supports lumbosacral radiculopathy. Because deficits are stable and no red flag is present, conservative care with early reassessment is reasonable. MRI is not mandatory at the first visit, but would be indicated for progression, cauda equina features, or failure to improve.
Traps
Labeling all leg pain as sciatica without neurological localization. Missing cauda equina or infection because the patient’s pain improved. Ordering advanced imaging for uncomplicated mechanical pain. Confusing hip or sacroiliac pain with radiculopathy. Failing to document negative red-flag findings and baseline neurological status.