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EXAMINATION OF CERVICAL DISORDER

Presented by Kaushal sinha 1st year PG Dept. of panchakarma SDM college of ayurveda

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CONTENT:- Introduction Region of spine Function of spine Examination of cervical spine(A)General pysical examination(B)Special test(C)Range of movement conclusion

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INTRODUCTION 33 vertebrae 31 pair nerve roots 23 disc Spinal cord- Contained in epidural space Network of sensory and motor

nerves Firm, cord-like structure

Conus medullarisFilum terminaleCauda equina

Foramen magnum

Conus medularis

Cauda equina

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SAGITTAL PLANE CURVES

Cervical Lordosis 20°- 40

Thoracic Kyphosis 20°- 40°

Lumbar Lordosis 30°- 50

Sacral Kyphosis

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REGION OF THE SPINE Cervical

Upper cervical: C1-C2

Lower cervical: C3-C7

Thoracic: T1-T12

Lumber: L1- L5

Sacrococcygeal: 9 fused vertebrae in the sacrum and coccyx

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FUNCTIONS OF SPINE:- Posture

Spinal cord encasement

Weight transmission

Posture

Vital organs back support

Muscles attachment

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WHAT IS CERVICAL SPINEConsist of 7 vertebra 8 nerves Give two plexuses:-Cervical plexus ( C1-C5)Phernic ( C3,C4,C5Lesser occipital (C2)Supraclaviclular ( C3,C4)brachial plexus ( C5-T1)mucocutanous n (C5-C7)axillary n (C5-C6)median n (C5-T1)radial N (C5-T1)ulnar n (C8-T1)

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CERVICAL DISORDER Cervical spondylosis Cervical radiculopathy Cervical myelopathy Cervical Strain/spasm Cervical Sprain Cervical Stenosis HNP(Herniated Nucleus pulposus) Cervical Cord Neuropraxia Fractures/subluxation etc.

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COMMON CONDITIONS AFFECTING THE CERVICAL SPINE

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Herniated disc- The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 - C5 level, and rarely the C7 - T1 level may herniate4

Cause- some sort trauma & injury

Bone spur- Cervical osteophytes are bone spurs that grow on any of the seven vertebrae in the cervical spine (neck), involving the spine from the base of the skull to the base of the neck (C1 - C7 vertebrae)

Cause- inflamed or damaged tissue,  cervical osteoarthritis, cervical spondylosis

Other types of arthritis, traumatic injury, and poor posture Narrow disc space- cervical foraminal stenosis (narrowing of the cervical

disc space) may arise without any disc herniation. The majority of symptoms with this type of cervical stenosis are usually caused by one nerve root on one side

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EXAMINATION OF CERVICAL SPINE

History General Examination Inspection Palpation Special Test Range of Movement

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EXAMINATION TECHNIQUE:- Introduce yourself Ask permission to perform examination Explain the patient appropriately The patient must be exposed properly Tell the patient to let you know if anything

you do uncomfortable and painful When female patient make sure that female

nurse & assistant is present.

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HISTORY Male / Female Occupation Socio economic class Presenting chief complaints History of presenting ilness Treatment history Past history Personal history Family history

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ASK FOR…

H/o Trauma H/o constitutional symptoms H/o Hemoptysis H/o Respirory symptoms,dysponea H/o Other joint involements H/o Pelvic inflammatory Treatment histoy Immunization history BCG,polio

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PAST HISTORY

Similar complains Prolonged history Previous surgery DM HTN Tuberculosis Hematological disorder Any neurological disorder

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PERSONAL HISTORY Smoking Alcohol Drug addiction Diet Bowel bladder habbit Appetite Menstrual history in female

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FAMILY HISTORY Similar illness Tuberclosis HTN DM

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INSPECTION(A) StandingLook from the side

normal spine> cervical lordosis

Increased lordosis – muscular weakness or imbalance

Lessened lordotic curve - muscular spasm/guarding and/or nerve root impingement

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(B) Position of Head Relative to

Shoulders Head should be seated symmetrically on

cervical spine

Lateral flexion - from unilateral spasm of muscles – strain

and/or spasm (guarding)

Rotation – from unilateral spasm of sternomastoid

muscle – strain and/or spasm (guarding) or torticollis

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PALPATION

Local rise in temperature Palpate all spinous process Prominent spinous process Feel → The midline spinous

processes → The paraspinal soft tissues → The supraclavicular fossae –

for cervical ribs or enlarged lymph nodes

→ The anterior neck structures including the thyroid

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SPECIAL TESTS

Cervical spine : Spurling test Compression test Distraction test Valsalva test Swallowing test Adson test

Range of motion:

Active Passive

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SPECIAL TEST:-Movement (A) Flexion

- ask the patient to bend the head forwards- chin should be able to touch the chest- normal : 80°

(B) Extension- ask the patient to look up and back- normal : 50°

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RANGE OF MOTION TESTING Active:- Best done in sitting or

standing

Flexion – touch chin to chest

Extension – look straight above head

Lateral flexion – approximately 45 degrees

Rotation – nose over tip of shoulder

Passive:- Best done laying supine

Flexion – firm end feel

Extension – hard end feel (occiput on cervical spinous processes)

Lateral flexion – firm end feel (stabilize opposite shoulder)

Rotation – firm end feel

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(C) Lateral flexion- ask the patient to touch his shoulder with the ear- involve atlanto-axial and atlanto-occipital joints- normal : 45°

(D) Rotation - ask the patient to look over his shoulder- normal : 80°- restricted and painful in cervical spondylitis

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COMPRESSION TEST Testing for compression of cervical

nerve root or facet joint irritation in the lower cervical spine

Ask the patient seat the table

Patient head is natural,therapist stands behind patient

Positive sign – Radiating pain or other neurological

sign in the same side arm(nerve root) and pain local to the neck or shoulder

A narrowing of neural foramen, pressure on the facet joints or muscle spasm can cause increase pain upon compression

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SPURLING TEST Same positioning as cervical

compression test

Compression of a cervical nerve root or facat joint irritation in the lower cervical spine

Patient slowly extends,sidebend,and rotates the head of affected side.

Therapist carefully compression downword on the head of patient

Positive sign:- Radiating pain or other

neurological sign in the same side arm(nerve root) and pain local to the neck or shoulder (facet joint irretation)

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DISTRACTION TEST To relive the pressure on the cervical roots (may be used after spurlling or compression test)

Place the open palm of one hand under the pt’s chin, and the other hand is upon occiput & tempolallis

Then, gradually lift (distract) the head to remove its weight from the neck

To demonstrate the effect that neck traction might have help in relieving the pain by decreasing pressure on the joint capsules around the facet joints.

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VALSALVA TEST Ask pt to hold his breath and bear down

as if he were moving his bowels

Then, ask whether he feels any increase in pain and describe the location

This test increase intratechal pressure

If a space occupying lesion, such as a herniated disc or a tumor present in cervical canal, pt may develop pain in cervical spine secondary to increase pressure

The pain also may radiate to the dermatome distribution of cervical spine pathology

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SWALLOWING TEST Difficulty or pain upon

swallowing can sometimes caused by cervical spine pathology such as :Bony protuberanceBony osteophytesSoft tissue swelling due

to hematomas, infection or tumor in ant portion of cervical spine

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LHERMITTE’S SIGN This sign detects protrusion of

cervical intervertebral disc or an extradural spinal tumour irritating the spinal duramater.

The patient sits on an examining table,now the head of the patient is bent down passively(flexion of cervical spine ) and simultaneously the lower limbs are lifted(flexing the hip joints) keeping the knees straight. This will causes sharp pain radiating down the spine and to both the extremities.

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ADSON TEST

Pull the arm downwards Palpate the radial pulse Turn the pt’s head to the same side and extend the neck  Abduct, extend, and laterally rotate the shoulder. From this position, have the patient take a deep

breath and hold Feel the radial pulse Fading of the radial pulse indicates positive thoracic outlet

obstruction

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CONCLUSION:- Facet joint spondylosis and herniation of the

intervertebral disc are the most common causes of nerve root compression.

Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques will lead to rapid diagnosis and improved patient care.

This knowledge is important for all practitioners. Rapid diagnosis and treatment will lead, ultimately, to a greater chance for early recovery for the patient affected by this condition.

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Thank you......