BY: KHUSHALI JOGANI The Sarvajanik College Of PhysiotherapyRampura,Surat

ASSESSMENT OF CERVICAL SPINE

Contents:

Introduction Patient history Observation Palpation Examination of movement Special tests Diagnostic imaging References

INTRODUCTION Cervical spine consists of 37 joints. It has been said that cervical spine moves

600 times per hour with normal activity. An area where stability is sacrificed for

mobility. Divided into two areas:

1)cervicoencephalic

2)cervicobrachial Lordotic curve in cervical region develops

at 3 to 4 months of age as child lifts head. At C4 to C5 interspace there is midpoint of

curve.

Line of gravity falls anterior to foramen magnum

Abnormality from normal lordotic curve leads to following:

Reduction in cervical lordosis

Increase in cervical lordosis

Resting position: slight extension

Closed packed position: full extension

Capsular pattern: side flexion and rotation equally limited,extension

PATIENT HISTORY Age and gender Occupation Address Dominant side and affected side Chief complaint Mechanism of injury Onset of problem

Location of Pain or other symptom when it started

Activities causing pain Duration and frequency of symptoms Has this occurred before and if so with

what it relieved ? Are the intensity,duration frequency

increasing? Is pain periodic, episodic,occasional? Is pain associated with

rest,activity,postures?

Did the head strike to anything? Radiation of pain? Is pain affected by laughing, coughing,

sneezing? Does the patient have headache,where,

frequency and does any position changes it?

Is paraesthesia present? Tingling or numbness (unilateral or

bilateral)? Any lower limb symptoms or difficulty in

walking or balance?

Quality of pain and site and boundaries of pain?

Is the condition improving? Worsening? Staying the same?

Activities aggravating or easing? Restriction of movement? Is there any difficulty in swallowing or

voice changes? Sleeping position and type of pillow? Any functional losses? Dizziness?

Medical history Drug history Surgical history Economic history Social history Pain history -VA Scale -Mc Gill –Melzack pain questionnaire -Thermometer pain rating scale

OBSERVATION Body built Assistive device Attitude of limb Posture( standing and sitting) lateral anterior posterior

Muscle spasm or any asymmetry? Facial expression? Any Trophic changes?

PALPATION Tenderness Trigger points Any muscle spasm or swelling? Texture of skin and bony and soft

tissues -posterior -anterior -lateral

EXAMINATION Range of motion tests Active movements to be checked -flexion, extension, rotation(right &left),

side flexion(right & left) -combined movement -repetitive movement -sustained position Overpressure applied to check end feel Normal end feel is tissue stretch(all

motions)

Tools used are -Goniometer -CROM -Inclinometer

Functional OA ROM Functional AA ROM

Resisted isometric movements

Peripheral joint scan Active range & overpressure -TM joint -scapula -Shoulder joint -elbow joint -wrist & hand MMT -cervical muscles

-scapular muscles Myotomes (if weakness is due to neurological

involvement) -neck flexion: C1-C2 -neck side flexion:C3 -shoulder elevation: C4 -shoulder abduction/shoulder lateral rotation:

C5 -elbow flexion and/or wrist extension:C6 -elbow extension and/or wrist flexion:C7 -thumb extension and/or ulnar deviation:C8 -abduction and/or adduction of hand

intrinsic:T1

Sensory examination Using light touch and pin prick on the

dermatomal levels on both ride and left side.

Reflex evaluation -biceps jerk(C5-C6) -triceps jerk(C7) -brachioradialis jerk(C6) -jaw jerk -hoffmann’s sign( if UMN suspected)

Functional assessment -activities of daily living -functional strength testing If tightness is suspected muscle length

test should be done. Checking for locking maneuver and

quadrant position for shoulder .

SPECIAL TESTS

Common test done in cervical spine are:

-foraminal compression test(spurling’s test)

-distraction test -upper limb tension test -shoulder abduction test -vertebral artery (cervical quadrant)

test

Craniocervical flexion test Thoracic inlet syndrome test -adson’s test -costoclavicular -hyperabduction -3 min elevated arm exercise

DIAGNOSTIC IMAGING

Plain film radiography -lateral view -open or odontoid view -oblique view CT Scan MRI

REFERENCES Orthopaedic physical therapy -DONNATELLI WOODEN (third

edition) Orthopaedic physical assessment -DAVID J.MAGEE(fifth edition) Orthopaedic examination,

evaluation,& intervention -MARK DUTTON