Brazilian Journal of Physical Therapy 27 (2023)100495Brazilian Journal ofBJPTabrapg ft:Physical Therapyhttps://www.journals.elsevier.com/brazilian-journal-of-physical-therapyMASTERCLASSA guide to identify cervical autonomic dysfunctions(andassociated conditions)in patients with musculoskeletaldisorders in physical therapy practiceFiras Mourad,b,Andrea Giudice,Giorgio Maritati,Filippo Masellid,Rik Kranenburg',Alan Taylors,Roger Kerry,Nathan Hutting.*Department of Physical Therapy,LUNEX International University of Health,Exercise and Sports,Differdange,LuxembourgLuxembourg Health Sport Sciences Research Institute A.s.b.1.,Differdange,LuxembourgDepartment of Physical Therapy,Poliambulatorio Physio Power,Brescia,ItalyDepartment of Human Neurosciences,Sapienza University of Rome,Rome,Italye Sovrintendenza Sanitaria Regionale Puglia INAIL,Bari,ItalyHealthy Ageing,Allied Health Care and Nursing Research Group,Hanze University of Applied Sciences,Groningen,the NetherlandssFaculty of Medicine and Health Sciences,School of Health Sciences,University of Nottingham,UKh Department of Occupation and Health,School of Organisation and Development,HAN University of Applied Sciences,Nijmegen,the NetherlandsReceived 27 January 2022;received in revised form 24 September 2022;accepted 6 March 2023Available online 17 March 2023KEYWORDSAbstractDifferential diagnosis;Background:Differential diagnosis is a hot topic in physical therapy,especially for those workingClinical reasoning;in a direct access setting dealing with neck pain and its associated disorders.All internationalNeck pain;guidelines agree in recommending to first rule out non-musculoskeletal pathologies as the causeSympathetic nervousof signs and symptoms in the patient.Although the autonomic nervous system (ANS)has a crucialsystem;role and is also involved in pain conditions,coverage of it in neuroscience textbooks and educa-Horner syndrometional programmes is limited and most healthcare professionals are unfamiliar with it.Althoughautonomic conditions are benign in nature,they are clinically of great importance as they maybe a'red flag'warning of an injury along the sympathetic pathway.Therefore,sound knowledgeof the ANS system is essential for clinicians.Objective:To develop physical therapists'knowledge of and confidence in understanding cervi-cal ANS function and dysfunction,thus enhancing clinical reasoning skills and the pattern recog-nition process,and performing and interpreting objective examinations.Methods:This master class provides an introductory guide and essential knowledge to facilitateclinicians to understand cervical autonomic dysfunctions and their clinical evaluation.The opti-mal referral method is also handled.Corresponding author at:Department of Occupation and Health,School of organisation and Development,HAN University of Applied Sci-ences,PO Box 690,6503,GL,Nijmegen,the Netherlands.E-mail:nathan.hutting@han.nl (N.Hutting).https:/1doi.org/10.1016/j.bjpt.2023.1004951413-3555/2023 The
