Assessment of Cervical Spine

Presented by -: Michelle Sheena Peters MPT Sports I Year

INTRODUCTION

The cervical vertebral column consists of seven vertebrae in total.

It is divided into two distinct regions: - The cervicoencephalic or cranioverterbral , the upper cervical spine consisting of C1 and C2 vertebrae. -The cervicobrachial , the lower cervical spine consisting of C3 to C7 vertebrae.

The manifestations of the injuries to the cervical spine depends on which part is affected . The injuries in the cervicoencephalic area have the following signs an symptoms -: Headache Fatigue Vertigo Poor concentration Hypertonia of sympathetic nervous system Irritability

Symptoms related to vertebral artery include: Vertigo Nausea Tinnitus Drop attacks (falling without fainting) Visual disturbances Stroke Death (rare) Pathology in the lower cervical spine leads to: Neck and/or Arm pain Headaches Restricted range of motion Paraesthesia Radicular signs

PATIENT HISTORY

I. Demographic Details
Name Age Gender Address Occupation Marital status Hand Dominance Referral

II. Chief complaint(s)

III. History of Present Illness

Duration of symptoms Onset of symptoms Trauma and Mechanism of trauma Nature of Sport Position in Game Protective Equipments Level of Competition Expected return to competition Change of training Behaviour of Symptoms

- Type of pain - Irritability - Mild Moderate Severe

- Severity of pain - Constant / intermittent pain - Body Chart - Stiffness - Night pain - Functional limitation - Diurnal Variation Neurological Symptoms - Any Radiation - Proximal / Distal Radiation - Any Paraesthesias - Weakness of the Part Vertigo or Dizziness

Body Chart

IV. History of Past Illness

Has the same condition occurred in the past? For eg. Has there been a

repeated ligament stain of the cervical spine. Was the athlete on steroids? Is he/ she regularly performing the exercises.

V. Genetic History VI. Medical / Surgical History

VII. Treatment History

EXAMINATION

I. Observation
Observation of the cervical spine -:

- Anterior view - Posterior view - Lateral view Shoulder level Muscle spasm / Asymmetry Facial Expression Local observation

Observation of cervical spine: (A) Anterior view, (B) Posterior view, (C) Lateral View

II. Active Movements

The active movements of the cervical spine are:
Flexion Extension Side flexion left and right Rotation left and right Combined movements (if necessary) Repetitive movements (if necessary) Sustained positions (if necessary)

Active movements of the cervical spine

III. Passive Movements

The passive movements and normal end feel are - : Flexion tissue stretch Extension tissue stretch Side flexion right and left tissue stretch Rotation right and left tissue stretch

IV. Resisted Movements

Cervical Spine Resisted movements: (A) Flexion (B) Extension (C) Side flexion (D) Rotation

V. Peripheral Joint Scan

Temporomandibular joint -: Open mouth

Close Mouth
Shoulder joints Abduction

Forward flexion Elevation through plane of scapula (SCAPTION) Apleys scratch test Rotation in 90 degrees of abduction
Elbow joints -

Flexion Extension Supination Pronation

Wrist and hand Flexion

Joints -

Extension Abduction Adduction Opposition of thumb and little finger

VI. Functional Assessment

Following activities can be asked to perform to check for the functional activities: Breathing Breathing should be normal. Swallowing Looking up the ceiling Looking down at Belt buckles or shoe laces Shoulder check Tuck chin in Poke chin out Neck strength

VII. Neurological Assessment

Sensory examination: The examiner can test the sensation by doing a sensory scanning examination for the dermatomes.

Reflex Testing For the cervical spine, the following reflexes should be checked: Biceps reflex (C5-C6)
Brachioradialis reflex(C5-C6) Triceps reflex(C7-C8) Jaw Jerk ( Cranial nerve V)

Reflex Testing

Myotomes

Cervical Myotomes are: Neck Flexion : C1-C2 Neck side flexion : C3 and Cranial nerve XI Shoulder elevation : C4 and CN XI 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 intrinsics : T1

Cervical Myotomes

VIII. Special Testing

Tests for Neurological Compression

Spurlings test

Maximum Cervical Compression Test

Distraction Test

Shoulder Abduction (Relief) Test

Shoulder Depression Test

Tinels Sign

Bikeles Sign

Brachial Plexus Tension Test

Upper Limb Tension Test

Tests for Upper Motor Neuron Lesion (Cervical Myelopathy) Rombergs Test Lhermittes Sign

Lhermittes Sign

Tests for Vascular Signs (Vascular Clearing Tests) Vertebral Artery (Cervical Quadrant) Test. Naffzigers Test

Naffzigers Test

Tests for Vertigo and Dizziness Temperature (Calorie) Test Dizziness Test Tests for Cervical Instability (Instability Clearing Tests) Signs and symptoms of cervical instability are; Severe muscle spasm Patient does not want to move head (esp. into flexion) Lump in throat Lip or facial paraesthesia Severe headache Dizziness Vomiting Nausea Soft end Feel Nystagmus Pupil changes

Pettmans Distraction Test

Sharp Purser Test

Anterior Shear or Sagittal Stress Test

Lateral Flexion Alar ligament Stress Test

Test for Cervical muscle Strength Craniocervical Flexion Test Test for First Rib Mobility

Craniocervical Flexion Test

Testing for First Rib Mobility

Tests for Thoracic Outlet Syndrome Roos Test Adson Maneuver

Roos Test

Adson Maneuver

IX. Palpation
Palpation shoud be performed to check - : Tender or trigger points Muscle spasms Texture of skin Soft tissue and bony contours

From the Anterior aspect structures palpated are : Hyoid bone Thyroid cartilage First cricoids ring Paranasal sinuses First three ribs Supraclavicular Fossa

From the Posterior aspect structures palpated are : External occipital protruberance Spinous processes Facet joints of cervical vertebrae Mastoid process
From the lateral aspect structures palpated are : Transverse processes of cervical vertebrae Lymph nodes Carotid Arteries Temporomandibular joints Mandible

X. Scales

Global Dimensions of the Neck Bournemouth Questionnaire

XI. Provisional Diagnosis

It is the hypothetical diagnosis which the examiner makes after the assessment.

ON-FIELD ASSESSMENT

On-field assessment clinical algorithm

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