Assessment of the cervical spine

1、 overview examination palpation special tests neurological exam circulatory exam examination arom arom arom with overpressure flexion (80 to 90o) extension (70o) lateral flexion (l depression, adduction, elevates ribs teres minor o: superior 2/3 of axillary border of scapula i: greater tubercle of t

2、he humerus a: external rotation, extension, rib elevation medius: o: transverse processes of c2-c7 i: rib 1 a: neck flexion rib elevation anterior: o: transverse processes of c3-c6 i: rib 1 a: neck flexion rib elevation special tests vertebral artery test distraction compression valsalva test swallo

3、wing/cough adson test spurlings sign (foraminal compression) grip strength wiggle fingers and toes pinch/reaction to pain vertebral artery test with patient supine, examiner supports pts head c both hands examiner slowly extends, rotates, & laterally flexes pts head to the l then r. hold each positi

4、on for 30” dizziness, blurred vision or slurred speech indicates complete or partial occlusion of vertebral artery utilize prior to traction or other manual therapy techniques distraction test examiner begins by placing the open palm of one hand under the pts chin with the other hand on the occipita

5、l bone at the base of the skull gentle, linear, traction-like pressure is then exerted to lift pts head positive test yields a relief of pain may be indicative of nerve root compression compression test examiner presses down on the crown of the pts head, looking for apprehension or signs of pain pt

6、should be either seated or supine positive test yields pain upon compression and may be indicative of narrowed neural foramen causing nerve root compression valsalva maneuver the examiner should instruct the pt to “bear down” as if performing a bowel movement this movement increases interthecal pres

7、sure and is positive if pain is felt upon performance may be indicative of a herniated disc swallowing/cough pain upon swallowing or coughing is considered a positive test that may be indicative of cervical spine pathology or soft tissue swelling adson test examiner begins by palpating the pts radia

8、l pulse pts arm is then abducted, extended, and externally rotated while the examiner continues to palpate the pulse pt is instructed to take a deep breath and turn the head toward the arm (look “ad” me) being tested a disappearance of the radial pulse is a positive test that indicates a compression

9、 of the subclavian artery by the medial scalene muscle spurlings sign examiner begins by placing the seated pts head in moderate lateral flexion & rotation examiner then pushes straight down on the top of the pts head sharp, shooting pain is a positive test for stinger / burner syndrome pain on the

10、same side as the head is flexed toward is probably indicative of cervical sprain while pain on the opposite side probably indicates muscle strain grip strength the patient is instructed to grasp examiners index and middle fingers of both hands and squeeze maximally the examiner should check for obvi

11、ous bilateral or unilateral strength deficiencies, possibly indicating motor nerve involvement wiggle fingers & toes the examiner instructs the patient to quickly flex and extend the fingers and toes. test is positive if athlete is unable to perform task and may indicate motor nerve involvement pinc

12、h & react to pain the examiner pinches the patient at the triceps, gastrocnemius, and elsewhere to look for sensory nerve response neurologic exam: sensory sensory dermatomes c2-c3: occipital area and angle of jaw c4: supraclavicular area axillary nerve patch: lateral aspect of shoulder c5: lateral

13、upper arm c6: lateral forearm, thumb, and index finger c7: middle finger and palmar aspect of hand c8: small finger, ring finger, and medial portion of palmar surface t1: medial side of forearm and elbow t2: medial aspect of upper arm t3: medial aspect of upper arm neurologic exam: motor c1-c2: neck flexion c1-c2: neck extension c3: neck lateral flexion c4: shoulder elevation c5: shoulder abduction and external rotation c6: elbow flexion and wrist extension c7: elbow extension and wrist flexion c8: thumb abduction and ulnar deviatio