examination of cervical spine
TRANSCRIPT
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Examination of spine
Cervical region
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Spine
• 33 bones
• 24 mobile individual segments– 7 cervical– 12 thoracic– 5 lumbar
• 2 lordotic 1 kyphotic
• Vertebral foramen
• Costal process
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Anatomy of vertebra
• Body• 2 pedicles• 2 sup facets• 2 inf facets• Trans process• Lamina• Spinous process• Cord - canal
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Relation of various parts of body
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Anatomy of cervical spine
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Ligaments of spine
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Strap muscles of neck
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Muscles of cervical spine
1. Semispinalis Capitus
2. Iliocostalis Cervicis
3. Longissimus Cervicus
4. Longissimus Capitus
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Problems
• Strain & Sprain
• Ivdp
• Facet artropathy
• Infection– Septic– Tuberculous
• Vascular
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History
• When/how• Intensity• Diurnal variation• Movements• Deglutation• Vomiting• Trauma • Constitutional symptoms
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Neurological history
• Pain first/weakness first• Progression• Sensory• Motor• ADL affected• Tight/loose• Clonus• Jerky movements• Locomotion/list
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Examination
• Look
• Touch
• Move
• Measure
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Inspection
• Posterior– Inion– Vertebra prominens– Muscle spasm– Both shoulders– Scapula– Interscapular region
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Anterior
• C3 – hyoid
• C4-5 - thyroid cartilage
• C6 – cricoid cartilage
• Sternum
• Notch
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Palpation
• Bone– Spinous process
– Transverse process
– Hyoid
– Cricoid Ring
– Inion
– Scapula
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• ROM • Flexion (80 to 90o)• Extension (70o)• Lateral flexion (L & R) (20 to 45o)• Rotation (L & R) (70 to 90o)• Shoulder elevation & depression
• PROM– Tissue stretch end feel for all
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Examination
– Flexion• Scalenes• Longus coli
– Extension• Levator scapulae• Trapezius• Splenius, semispinalis, & longissimus cervicis
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Examination
– Lateral flexion• Trapezius• Longus capitus• Sternocleidomastoid
– Rotation• Levator scapulae• Sternocleidomastoid
– Shoulder elevation
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Sternomastoid
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Extension strength
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Flexion strength
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Lateral flexion
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Examination
• Peripheral joint scanning– TMJ– Shoulder girdle– Elbow– Wrist and hand
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Special Tests
• Vertebral Artery Test
• Distraction
• Compression
• Valsalva Test
• Swallowing/cough
• Adson Test
• Spurling’s Sign (Foraminal Compression)
• Grip Strength
• Wiggle Fingers and Toes
• Pinch/Reaction to Pain
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Vertebral Artery Test• With patient supine,
examiner supports pt’s head in both hands
• Examiner slowly extends, rotates, & laterally flexes pt’s head to the L then R.
• Hold each position for 30 sec
• Dizziness, blurred vision or slurred speech indicates complete or partial occlusion of vertebral artery
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Distraction Test• Examiner begins by placing the
open palm of one hand under the pt’s chin with the other hand on the occipital bone at the base of the skull
• Gentle, linear, traction-like pressure is then exerted to lift pt’s head
• Positive test yields a relief of pain
• May be indicative of nerve root compression
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Compression Test• Examiner presses down on the
crown of the pt’s head, looking for
apprehension or signs of pain
• Pt should be either seated or supine
• Positive test yields pain upon
compression and
• indicative of narrowed neural
foramen causing nerve root
compression
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Spurling’s test
• Extend neck
• Rotate it to involved side
• Complains of pain
• Indicative of nerve root compression
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Lhermite’s sign
• Flex c-spine and thoracic spine
• Parasthesia on trunk/limbs
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Valsalva Maneuver
• The examiner should instruct the pt to “bear down” as if performing a bowel movement
• This movement increases interthecal pressure and is positive if pain is felt upon performance
• May be indicative of a herniated disc
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Swallowing/Cough
• Pain upon swallowing or coughing is considered a positive test that may be indicative of cervical spine pathology or soft tissue swelling
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Adson Test• Examiner begins by palpating the pt’s
radial pulse• Pt’s 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 of the subclavian artery by the medial scalene muscle
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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
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Cervical spinal stenosis
• UMN below lesion level
• LMN above lesion level
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Neurologic Exam: Sensory
C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of
shoulder C5: Lateral 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
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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 deviation T1: Finger approximation
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Neurologic Exam: Reflexes
Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)
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ULT test 1
• C5-7 roots
Upto 1100
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Circulatory
• Carotid
• Brachial
• Radial