Cervical Spine Ove Indergaard MSc MCSP HPC

Anatomy

Spinal Movement

Anatomy

Objective Examination Observation: posture, compensatory postures, atrophy/spasm Movement: Active and Passive, Quality, Range and production of symptoms Neurological Assessment: Myotomes, Dermatomes, Reflexes, AND tests Special Tests: Spurlings, Brachial plexus, Thoracic outlet Neurological assessment: relexes, SLR, PKB, myotomes, dematomes, plantar reflexes

Posture

Movement Testing Cervical Spine: Flexion Extension Rotations Sideflexions Supine tests Thoracic Spine Shoulders

Neurological Testing

Dermatomes

Special Tests Spurlings test / Foraminal Compression Test Positive Positive Pain in UE toward side laterally flexed Pain in UE toward side laterally flexed postive test 95% sensitive to nerv root pathology postive test 95% sensitive to nerv root pathology Indications Indications Pressure on nerve root Pressure on nerve root Considerations Considerations + vertebral artery test + vertebral artery test Osteoarthritis, osteoporosis, spinal stenosis or cervical spine instability Osteoarthritis, osteoporosis, spinal stenosis or cervical spine instability

Foraminal Distraction Positive Positive Existing complaints disappear or decrease Existing complaints disappear or decrease Indications Indications Nerve root impingement during normal posture Nerve root impingement during normal posture Increase in pain may indicate muscle or ligament injury Increase in pain may indicate muscle or ligament injury

Special Tests Brachial plexus Positive Positive Radiating pain on side tilting away from = brachial plexus Radiating pain on side tilting away from = brachial plexus Radiating pain on side tilting towards = nerve root impingement Radiating pain on side tilting towards = nerve root impingement Considerations Considerations fracture fracture

Special Tests Thoracic Outlet: Allen’s Test Positive Positive Diminished radial pulse Diminished radial pulse Indications Indications Thoracic Outlet Syndrome Thoracic Outlet Syndrome Adson’s Test Positive Positive Reduced or altered radial pulse Reduced or altered radial pulse Indications Indications Thoracic Outlet Syndrome Thoracic Outlet Syndrome

Thoracic Outlet Cont Positive Positive Inability to maintain test position Inability to maintain test position Diminished hand function Diminished hand function Loss of sensation in UE Loss of sensation in UE Indications Indications Thoracic Outlet Syndrome Thoracic Outlet Syndrome

Management of Acute Neck Injuries (whiplash)

Whiplash cont

Management of Chronic Neck Pain Intervention & Treatment Recommendations evidence based guidelines (JOSPT 2008) Cervical ManipulationCervical Manipulation/Mobilisations alongside coordination, strengthening, & endurance exercises (Grade: A)ngthening, & Patient Education and Reassurance are important throughout treatment. (Grade: A) The use of upper quarter and nerve mobilisation procedures can be useful in the treatment of patients with neck pain. (Grade: B) These interventions have been shown beneficial and are even more effective when paired with manual therapy and exercise.ents with neck pai Use of Thoracic Mobilisation/Manipulation (Grade: A) The use of thrust manipulations and mobilisations have been shown more recently (2012) that it can reduce symptoms in patients with neck and neck related arm pain.ipulations and Use of Stretching (Grade: C) Stretching involved musculature can be beneficial for patients with neck pain. Activity Limitations (Grade: F) The patient should be limited to functional activity that does not cause an increase in symptoms throughout the treatment period. This helps the clinician to assess changes in the patients level of function during an episode of care.

Common exercises Acute: ROM exercises Chronic: Dysfunction specific, can be stretches, motor control, stabilisations, general strength