Assessment of the cervical spine.ppt

assessmentofthecervicalspine part2 overview examinationpalpationspecialtestsneurologicalexamcirculatoryexam examination aromaromaromwithoverpressureflexion 80to90o extension 70o lateralflexion l r 20to45o rotation l r 70to90o shoulderelevation depressionpromtissuestretchendfeelforall examination manualmuscletesting isometricbreaktesting don tletmemoveyou bull yourneck flexionextensionlateralflexionrotationshoulderelevation examination mmtflexionscaleneslonguscoliextensionlevatorscapulaetrapeziussplenius semispinalis longissimuscervicis examination mmtlateralflexiontrapeziuslonguscapitussternocleidomastoidrotationlevatorscapulaesternocleidomastoidshoulderelevation examination peripheraljointscanningtmjshouldergirdleelbowwristandhand palpation bonespinousprocesstransverseprocesshyoidcricoidringinionscapula palpation softtissuethyroidnodessternocleidomastoido manubrium medialclaviclei lateralmastoidprocessa unilateralrotationtooppositeside bilateralheadflexion palpation softtissuelevatorscapulaeo transverseprocessesofc1 c4i superiorvertebralborderofscapulaa elevation downwardrotation depression adduction downwardrotationofthescapula palpation softtissueserratusanterioro upper8or9ribsi vertebralborderofthescapulaa upwardrotationelevatesribsteresminoro superior2 3ofaxillaryborderofscapulai greatertubercleofthehumerusa externalrotation extension adductionofthehumerus palpation softtissueinfraspinatuso infraspinousfossaofscapulai greatertubercleofthehumerusa externalrotation adductionofthehumerussubscapulariso subscapularfossaofanteriorscapulai lessertubercleofthehumerusa internalrotationofthehumerus palpation softtissuerhomboideusminor o spinousprocessesofc7 t1i vertebralborderofscapulaabovespinea scapularadduction downwardrotationmajor o spinousprocessesoft2 t5i vertebralborderofthescapulabelowspinea scapularadduction downwardrotation palpation softtissuetrapeziussuperior i o spinousprocessofc7 upi lateral1 3ofclavicleandacromiona elevation adduction andupwardrotationofthescapulamedial ii o spinousprocessesoft1 t5i superiorborderofscapularspinea elevationandadductionofthescapulainferior iii o spinousprocessesoft6 t12i medial1 3ofscapularspinea depression upwardrotation andadductionofthescapula palpation softtissuescalenesposterior o transverseprocessesofc4 c6i rib2a neckflexionribelevation specialtests vertebralarterytestdistractioncompressionvalsalvatestswallowing coughadsontestspurling ssign foraminalcompression gripstrengthwigglefingersandtoespinch reactiontopain vertebralarterytest withpatientsupine examinersupportspt sheadcbothhandsexaminerslowlyextends rotates laterallyflexespt sheadtothelthenr holdeachpositionfor30 dizziness blurredvisionorslurredspeechindicatescompleteorpartialocclusionofvertebralarteryutilizepriortotractionorothermanualtherapytechniques distractiontest examinerbeginsbyplacingtheopenpalmofonehandunderthept schinwiththeotherhandontheoccipitalboneatthebaseoftheskullgentle linear traction likepressureisthenexertedtoliftpt sheadpositivetestyieldsareliefofpainmaybeindicativeofnerverootcompression compressiontest examinerpressesdownonthecrownofthept shead lookingforapprehensionorsignsofpainptshouldbeeitherseatedorsupinepositivetestyieldspainuponcompressionandmaybeindicativeofnarrowedneuralforamencausingnerverootcompression valsalvamaneuver theexaminershouldinstructtheptto beardown asifperformingabowelmovementthismovementincreasesinterthecalpressureandispositiveifpainisfeltuponperformancemaybeindicativeofaherniateddisc swallowing cough painuponswallowingorcoughingisconsideredapositivetestthatmaybeindicativeofcervicalspinepathologyorsofttissueswelling adsontest examinerbeginsbypalpatingthept sradialpulsept sarmisthenabducted extended andexternallyrotatedwhiletheexaminercontinuestopalpatethepulseptisinstructedtotakeadeepbreathandturntheheadtowardthearm look ad me beingtestedadisappearanceoftheradialpulseisapositivetestthatindicatesacompressionofthesubclavianarterybythemedialscalenemuscle spurling ssign examinerbeginsbyplacingtheseatedpt sheadinmoderatelateralflexion rotationexaminerthenpushesstraightdownonthetopofthept sheadsharp shootingpainisapositivetestforstinger burnersyndromepainonthesamesideastheheadisflexedtowardisprobablyindicativeofcervicalsprainwhilepainontheoppositesideprobablyindicatesmusclestrain gripstrength thepatientisinstructedtograspexaminer sindexandmiddlefingersofbothhandsandsqueezemaximallytheexaminershouldcheckforobviousbilateralorunilateralstrengthdeficiencies possiblyindicatingmotornerveinvolvement wigglefingers toes theexaminerinstructsthepatienttoquicklyflexandextendthefingersandtoes testispositiveifathleteisunabletoperformtaskandmayindicatemotornerveinvolvement pinch reacttopain theexaminerpinchesthepatientatthetriceps gastrocnemius andelsewheretolookforsensorynerveresponse neurologicexam sensory sensorydermatomesc2 c3 occipitalareaandangleofjawc4 supraclavicularareaaxillarynervepatch lateralaspectofshoulderc5 lateralupperarmc6 lateralforearm thumb andindexfingerc7 middlefingerandpalmaraspectofhandc8 smallfinger ringfinger andmedialportionofpalmarsurfacet1 medialsideofforearmandelbowt2 medialaspectofupperarmt3 medialaspectofupperarm neurologicexam motor c1 c2 neckflexionc1 c2 neckextensionc3 necklateralflexionc4 shoulderelevationc5 shoulderabductionandexternalrotationc6 elbowflexi