Evaluation of the Cervical Spine By B.Nelson

Outline of presentation Review of anatomy of CS Steps in evaluation of CS Common conditions affecting the CS

Review of anatomy Structure of Cervical Spine

History The history often gives the therapist clues as to the source of the patient’s symptoms, nature and location of the involved structure ,the severity of the condition , and the activities or positions that aggravate or improve the patient’s condition

Examination /observation Observation of the general posture as well as the relationship to the neck on the trunk and the head on the neck is observed when the patient is sitting, standing in the waiting room and the examination room Clothing should be removed to expose the area

Observation cont’d Anterior- chin in line with sternum Levels of the shoulder ( dominant side slightly lower than non- dominant side) Lateral- ears in line with shoulder, lordotic curve Note the presence of Torticollis “poking chin”

Observation cont’d Posterior- relationship between the CS and the rest of the spine Muscle spasm or asymmetry

Movements- Active Upper cervical spine – Flex - nod Ext – lift the chin without moving the neck Lower cervical spine- flex ,ext, S. Flex, rot NB; look for difference in range and ease to move Most painful movement done last

Passive Movements & end feel Done in supine Greater ROM due to muscles being more relaxed Normal end feel for all cervical movements is tissue stretch

Resisted movements Place the CS in a neutral position Stabilise the trunk Movts- flex, ext ,S.Flex & Rotation the command for resisted movts is “Don’t let me move you”

Scanning of peripheral joints To rule out pathologies in the peripheral joints Temporomandibular jts Shoulder joints Elbow joints Wrist and hand joints Screen the glenohumeral ,acriomioclavicular, sternoclavicular and scapulothoracic joints

Muscle Power & myotome Neck flexion (C1- C2 myotome) Neck side flexion (C3 myotome) Shoulder elevation (C4 myotome) Shoulder abduction (C5 myotome) Elbow flexion (C6) Elbow or wrist extension (C7) Thumb extension (C8) Finger abduction (T1)

Muscles of the CS

Muscles of the CS

Muscles of the CS

Special tests Vertebral artery test – the vertebral artery is vulnerable to injury as it passes from the CS transverse processes to the cranium Several tests – Vertebral artery test Vertebrobasalar insufficiency leads to ischemic symptoms from the pons medulla and creebellum Dizziness, malaise and nausea, vomiting visual disturbance

Palpation Position of patient – Supine , prone , or sitting with the head resting on the forearm which is at shoulder level Palpate the posterior structures of the neck, lateral and anterior Supine muscles are fully relaxed

Posterior aspect Spinous processes of C2 – C7 Mastoid process Lateral aspect- transverse processes TM jt , mandible parotid glands Anterior aspect- first 3 ribs Palpate the manubrium moving the fingers along laterally is the path of the firsr 3 ribs

Investigation Imaging X-rays MRI

Common conditions of the CS Cervical spondylosis Spinal stenosis Cervical rib/Thoracic Outlet Syndrome Cervical Nerve Root impingement Brachial Plexus

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