Transcript Evaluation of the Cervical Spine

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
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
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
Posterior aspect
• Spinous processes of C2 – C7
• Mastoid process
• Lateral aspect- transverse processes
• TM jt , mandible parotid glands
• Anterior aspect- first 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
Suggested text
• Orthopaedic Physical Assessment by David
Magee
• Orthopaedic Medicine by Monica Kesson and
Elaine Atkins
• Living Surface Anatomy by Philip Harris and
Craig Ranson