Cervical Flashcards
4 Movements of C-spine
FL
EX
ROT
LF
Capsular Pattern (most-least limited motion) of c-spine
Side FL & Rotation (equally limited)
EX
C-spine Rule out
- TMJ
- Thoracic spine (all mvmnts with overpressure)
- Shoulder (FL & AB)
- VBA (vertebral- basilar-artery)
VBA
Supine
- Head off the table
- Keep eyes open
- Talk or count 30 secs
- EX/ ROT/ LF (off the table)
- Px counts 30 secs
Spurling’s Test
Foraminal Compression Test
Cervical Radiculopathy
Positive
Pain Radiating into the arm toward which head is LF during compression
- LF head to affected side
- Th- Direct Downward Pressure on the head
* can be done in Supine
* Variation: Slight EX &LF with axial load
Implications by narrowing the intervertebral foramen
- Stenosis
- Cervical spondylosis
- Osteophytes
- Trophic, arthritic, inflamed facets
Cervical Compression Test
Cervical Radicuropathy
Positive
Pain radiating into the arm
- Px- supine Neck neutral
- Th- Downward pressure
Distraction Test
Right after Compression Test!
Alleviate Symptoms of radicular nature
Positive
Pain relieved or ↓when head is lifted or distracted
Implications
1. Px- AB arms while traction is applied, s/s alleviates
especially; C4-C5 nerve roots involvement
Cervical Upper Quadrant Test
Facets jt irritation C0-C2
Positive
- Local pin point Pain
- Referral Pain - apophyseal jt referred pain patterns
- Supine - Head Off the table
- Px’s head passively EX
- Ipsilateral LF
- Contralateral ROT
Implications
- Max closes the intervertebral foramen (reticular symp)
- Stop if pain
Cervical Lower Quadrant Test
Facet jt irritation C2-C7
Positive
- Local Pin Point Pain
- Referral pain - follows apophyseal jt referred pain
- Supine / Head off the table
- Neck passively EX
- LF
- Ipsilateral Rot
Implications
1. Max close the intervertebral foramen
Valsalva Test
↑ pressure on the spinal cord
Positive
- ↑Pain due to intrathecal pressure
- Redicular PAIN Symptoms down the arms
Implications
- herniated disc
- Tumour
- Stenosis
- Osteophytes
Tinel’s Sign
Brachial Plexus Lesion C5-T1
Positive
Tingling sensation in the distribution of nerve on ipsilateral side
- Supine
- LF of neck
- Tap at TVP C5-T1
Implications
Some recovery happening
Pain- Neuroma
Chvostek’s Test
Hyperexcitibility of the Facial nn
Positive
Twitch of the massetar mm or the lateral lip
- Tap on massetar mm where parotid gland sits
(near angle of mandible)
Hautant’s Test
Vascular Problems
(Differentiate Dizziness or Vertigo → articulate problems)
Positive
- If arms move w/o neck Rot and EX- NON Vascular
- If arms move with Necl Rot and EX - Vascular impairment to brain
- Px sitting & forward FL both arms 90 degree
- Eyes close
- 30secs
- If unaltered, px Rot & EX
Implications
*possible VBA occlusion
Sharp-Purser test
Subluxation of the Atlas on the axis (transverse lig tear)
Positive
- Th feels the head slide backward the movement
- May hear a “CLUNK”
- Th - stabilize forehead
- Press the SPs
*Apprehensive To do Forward FL
Transverse Ligament Stress test
Transverse Ligament integrity b/w C1-C2
Positive
- Soft end feel
- mm spasm, dizziness nausea, parasthesia of lip, face, nystagmus/ lump sensation in the throat
Dermatomes
C5- Lateral shoulder C6- Thumb & index finger C7- Middle finger C8- 4th and 5th fingers T1- Medial elbow
Myotomes
C1-C2 - Neck FL
C3 - Neck LF
C4 - Shoulder Elevation
C5 - Shoulder Ab
C6 - Elbow FL and Wrist EX (I don’t know gesture)
C7 - Elbow EX and Wrist FL (かくれてチップちょうだい）
C8 - Thumb EX and Ulnar deviation (Palm up)
T1 - Hand intrinsic (指を広げる）
DTR
C5 Bicepital reflex (hit on the th’s thumb)
C6 Brachiradial reflex (Neutral)
C7 Triceps
