(2) Cervical Spine Examination and Evaluation

Question 1

Provide the most common cervical pathologies for each of the following age groups:

Young (<30 y/o)
Middle Age (30-60 y/o)
Older (>60 y/o)

Answer 1

Young (<30 y/o): Ligament sprain / muscle strain

Middle Age (30-60 y/o): Cervical pathology most prevalent in this age group

Older (>60 y/o): Spondylosis and/or Spinal Stenosis

Question 2

Bilateral vs. Unilateral Radiation of Symptoms

Answer 2

Bilateral: Myelopathy (SC) / central dysfunction

Unilateral: Radiculopathy / peripheral dysfunction

Question 3

Presence of Cranial Nerve Signs (5 D’s, 3 N’s)

Answer 3

Dizziness / Drop Attacks / Diplopia / Dysarthria / Dysphagia

Nausea / Numbness / Nystagmus

+ Ataxic Gait / Gaze Disturbances

Question 4

The presence of neck pain with coughing and / or sneezing may be indicative of ___.

Answer 4

disc pathology

Question 5

Patient Health Questionnaire (PHQ-2) Screening Questions

Answer 5

Over the past 2 weeks, how often have you had little interest or pleasure in doing things?

Over the past 2 weeks, how often have you felt down / depressed / hopeless?

Question 6

3 Mandatory Questions for Patients w/ Neck Pain

Answer 6

1: Any dizziness (vertigo), blackouts or “drop” attacks? - Vertebral Basilar Artery Insufficiency (VBI) / 5 D’s and 3 N’s

2: Any history of RA, other inflammatory arthritis, or treatment with systemic steroids? - CV instability or ligamentous insufficiency / joint degradation can lead to excess motion

3: Any neurological symptoms in the legs? - Cervical Myelopathy / some form of SC compression

Question 7

Canadian C-Spine Rules

Answer 7

Indication: ANY history of trauma and no imaging

Purpose: Determine whether Radiography is necessary prior to initiating PT treatment

Sitting position / ambulatory immediately after accident

Current absence of midline c-spine tenderness

Question 8

When are the Canadian C-Spine Rules NOT applicable?

Answer 8

Non-trauma cases

Glasgow Coma Scale <15

Unstable vital signs

Age <16

Acute paralysis

Known vertebral disease

Previous c-spine surgery

Pregnant

Question 9

How can you distinguish between a ROM deficit that is related to a muscular issue from that of a joint issue?

Answer 9

PROM > AROM: muscle problem

PROM = AROM: joint problem

Question 10

Possible Causes for Decreased Extension and R SB ROM

Answer 10

R extension hypomobility

L flexor muscle tightness

Anterior capsular adhesions

R subluxation

R small disk protrusion

Question 11

Possible Causes for Decreased Flexion and R SB ROM

Answer 11

L flexion hypomobility

L extensor muscle tightness

L posterior capsular adhesions

L subluxation

Question 12

Possible Causes for A Extension and R SB Deficit > Extension and L SB Deficit

Answer 12

L capsular pattern (arthritis / arthrosis)

Question 13

Possible Causes for A Flexion and R SB Deficit = Extension and L SB Deficit

Answer 13

Left Arthrofibrosis (very hard capsular end-feel)

Question 14

Possible Causes for SB Deficit in Neutral / Flexion / Extension

Answer 14

Uncovertebral hypomobility or anomaly

Question 15

Cervical Spine ROM Norms

C0 - C2 / C2 - 7 / Total

Answer 15

C0-C1:
Flexion - 5 / Extension - 10
Rotation - minimal, conjunct
SB - 5

C1-C2:
Flexion - 5 / Extension - 10
Rotation - 35-45
SB - 0

C2-7:
Flexion - 35-70 / Extension - 55-60
Rotation - 30-45
SB - 15-40

Total C-Spine:
Flexion - 80-90 / Extension - 60-70
Rotation - 75-90
SB - 20-45

Question 16

Cervical Radiculopathy CPR (Wainner)

Answer 16

1. C-Spine rotation to painful side <60 degrees
2. (+) Spurling Test
3. (+) ULTT #1
4. (+) Cervical distraction test (relieves symptoms)

3/4 to 4/4 = 65-90% likelihood of Cervical Radiculopathy