Cervical Flashcards
Observations
So I’m looking for any obvious signs of
Bumps/Bruises/Redness/Scars/Swelling/Muscle Wasting/Discoloration/Alignment –
Muscle wasting – which could be associated with cervical spondylosis
Lumps – could indicate a possible Lymphoma, especially around the Jaw
Swelling – Possible fracture which could occur due to MVA or whiplash
Bakody’s sign –
* Where a patient places a hand over their head on the affected side to relieve pressure and decrease pain
* This elevates the suprascapular nerve and reduces traction on the lower trunk of the brachial plexus which reduces the traction on a compressed nerve
* It could indicate disc prolapse or IVF compression
Rust sign –
* This is where a patient is supporting their head or neck with both hands particularly after some form of trauma
* This would be a red flag for some structural deformity in the neck after a trauma
* This could indicate that there is a fracture in the cervical spine, instability in the cervical spine, or cervical subluxation
Torticollis –
* This is a contracted state of the cervical muscles which produces a twisting of the neck where the head twists to one side.
* The most common cause is a contracture of the SCM muscle and is and is the most common etiology for torticollis in infants.
Rounded shoulders
* Upper cross syndrome (s a muscle imbalance caused by the weakening and lengthening of the posterior upper back and neck muscles, combined with the tightening and shortening of the opposing anterior pectoral (chest) and neck muscles)
SCM/Levator scapula
* Spasms
Patient in a side flexed position
* Compression - Could suggest that patient pain is caused by a compression on the side their flexed. (increases on pressure on cervical spine joint ie facet,)
* Adaptation - Could be side flexed in order to adapt to pain on the other side (open up/offload the other side)
* Maladaptation – This is where the patient originally adapted to relieve their pain but they are unable to correct their position. This means that overtime they have stretched the other side to much which could be a cause for their pain.
Lateral view –
Laterally I can observe for
Forward head posture –
* Which could indicate weak deep neck flexors, weak Lower trapezius
* Overactive and Levator scapula, tight upper traps as well as neck extensors such as splenius capitis (which means could have pain in that area)
Increased Lordosis –
* Which could indicate osteoporosis (65 F)
Decreased Lordosis –
* Could indicate DDD, OA
Posterior View -
Ear Levels – Checking for asymmetry and any deviation between the right and left isdes
Positioning of the spine –
* Checking if the cervical spine runs straight down to the Thoracic spine
* Scoliosis - Lateral tilt of the skull, due to difference in muscle length to the right and left side (which puts more pressure on one side of the cervical spine)
Palpation
Ask patient to lie in prone position –
Posterior start
Occipital protuberance
* Which is the nuchal ligament origin and attachment point for the upper trapezius which is a common site for trigger points and non-specific neck pain
Move down to Soft space Atlas - C1
* Mention no Sp
* Where Atlantoaxial joint is
C2, C3,C4,C5,C6,C7
* Do P to A pressure for each one and ask patient to extend their neck in order to locate C7.
Facet Joints
* 1.3cm-2.5cm lateral to Sps
* P to A pressure for each one down to C7
Ask patient to sit up – Lateral
Palpate
Mastoid process
* This is where the SCM extends from and goes down into your sternum
* Insertion point for Splenius capitis and Longissumus capitis
TVPs – Very lateral
* TVp 1 to 4 is the origin for levator scapula
* This is also attachment point for the scalenes with the
* anterior scalenes originating from 3 to 6 and inserts into the 1st rib
* Middle scalene from Tvps of C2 to C7 and insert into the 1st rib
* Posterior scalenes Originate from Tvps of C5 to C7 and insert onto the 2nd rib
Lymph node
*
Carotid artery –
* Major blood vessel that provides blood supply to the brain, blocked CA can cuase a stroke.
TMJ –
* Which can also be a common site of pain as temporomandibular disorders can cause stiffness around the jaw, ear and temple
Anterior –
Hyoid Bone
* Suspended by ligaments and muscles
* Can be fractured during strangulation
* Supports the tounge and provides attachment sites for tongue and neck muscles
Thyroid Gland –
* It produces hormones that regulate the bodys metabolism (T3 and T4 hormones)
SCM, First rib, Scalenes
ActiveROM
AROM - let me know if you feel pain during any part of these movements
Cervical flexion
* Could you please try touch your chin to your chest
* 50 to 70* normal
Extension
* Could you please look up towards the ceiling
* 50 to 90* normal
Lateral flexion
* Could you please bring your ear towards your shoulder
* 40 to 50* normal
Rotation –
* Could you please try to look over your shoulder
* 70 to 90* normal
* Part of the cluster of weiner test and is considered positive if ROM is less than 60*
PassiveROM – Passive overpressure
Extension –
* This can also be described as the extension compression test, This causes the IVD spaces to decrease posteriorly and increase anteriorly with an increased load on the facet joints.
* If patient has symptoms and they decrease during this movement it could be a sign of a prolapsed disc, due to the anterior displacement of discal material
* If there is an increase in radiating arm pain it could be IVF encroachment due to osteophytes or from another source
* Increased localised pain could be facet joint problems
Flexion –
* This could also be describes as flexion compression test
* This causes the IVDs to be compressed and causes them to bulge posteriorly
* An increase in cervical or radicular symptoms may indicate discal problems
* This position reduces load on the facet joints therefore reduced localised pain may indicate facet joint irritation-/
Lateral flexion –
* This could be described as the Jacksons compression test
* This test is positive if it exacerbates or reproduces radicular symptoms
* If it produces localised pain, it could be an issue with the facet joints
Rotation –
* Over pressure
RIMs (Don’t let me move you) Ask patient to keep head in certain positions. Apply the force (Rotation, Lateral Flexion, Rotation) Often applied from mid ranges.
Resisted isometrics –
When assessing patient’s movements look for pain and power
Apply force in mid-range
Score power 0 to 5
Flexion –
* Left hand on patient and right hand on patient back, Ask patient to touch chin to neck and resist with left hand
Extension –
* Left hand on left shoulder, right hand on posterior aspect of patients head
Lateral flexion
* Stand in front of patient
* One hand on opposite shoulder of flexion and other hand on the lateral aspect of patient forehead
Rotation
* Stand in front of patient
* One hand on opposite shoulder of rotation and other on the lateral aspect of patient forehead
* Ask patient to rotate to left side and right side
Special Tests
