Cervical/Neck

Question 1

What should you do first before beginning the cervical spine/neck physical exam?

Answer 1

Sanitize Hands

Question 2

What is the first step of the cervical spine/neck physical exam?

Answer 2

Inspection of cervical spine/neck. Remember to verbalize findings

Question 3

What are you looking for during inspection of the cervical spine and neck?

Answer 3

• Scars, trauma, masses, goiters
• Carrying angle
• Increased, decreased lordosis
• Distended External Jugular Vein (increased JVP); have pt lie down wit head rest at 30 degree angle
• Tracheal Deviation
• Masses in the neck
• Mediastinal mass, large pneumothorax

Question 4

What are you looking for when palpating the cervical spine/neck?

Answer 4

Palpate the following structures:

• Skin
• Cervical Spine (spinous processes, transverse processes)
• Cervical Muscles
• Trachea
• Palpate thyroid (MUST DO POSTERIOR TECHNIQUE: stand behind pt, have them flex neck slightly, place fingers of both hands just below crichoid cartilage and have pt swallow; then displace trachea to right to palpate for right lobe, and vice versa for left lobe)

Question 5

What is the third step of the cervical spine?

Answer 5

Perform range of motion testing of the cervical spine/neck

Question 6

What are you looking for in range of motion testing of the cervical spine /neck?

Answer 6

• Flexion of cervical spine (45-90)
• Extension of cervical spine (45-90)
• Rotation of cervical spine (70-90)
• Sidebending of cervical spine (20-45)

Question 7

What is the normal range of motion of cervical spine flexion?

Answer 7

45-90

Question 8

What is the normal range of motion of cervical spine extension?

Answer 8

45-90

Question 9

What is the normal range of motion of cervical spine rotation?

Answer 9

70-90

Question 10

What is the normal range of motion of cervical spine sidebending?

Answer 10

20-45

Question 11

What is the fourth step of the cervical spine/neck physical exam?

Answer 11

Perform upper extremity strength testing. Remember to verbalize results

Question 12

What are you looking for when conducting upper extremity strength testing?

Answer 12

• Shoulder Flexion
• Shoulder Extension
• Shoulder shrug
• Shoulder Abduction (move arm up toward head in coronal plane)
• Shoulder Adduction (move arm down toward waist in coronal plane)
• Shoulder Horizontal Abduction
• Shoulder Horizontal Adduction
• Internal Rotation of Arm
• External Rotation of Arm
• Elbow Flexion
• Elbow Extension
• Pronation
• Supination

Question 13

What is the fifth step of the cervical spine/neck physical exam?

Answer 13

Perform sensory testing on upper extremities bilaterally.

Question 14

What are you looking for on sensory testing of the upper extremities?

Answer 14

• Have pt close their eyes
• Tell pt to let you know where and when they feel you touch them
• Touch pt’s thumb on one of their hands, then test again with the other thumb
• This tests the C6 dermatome

Question 15

What is the sixth step of the cervical spine/neck physical exam?

Answer 15

Perform upper extremity deep tendon reflex test (just one)

Question 16

What are you looking for on the deep tendon reflex test of the upper extremity?

Answer 16

• Biceps reflex (C5 nerve root)
• Brachioradialis (C6 nerve root)
• Triceps (C7 nerve root)

Scaled out of 4

• Normal is +2/4
• 0 is no reflex
• +1/4 is weak reflex
• +3/4 is a brisk reflex
• +4/4 is an abnormal clonus (repetitive reflex)

Question 17

What is the seventh step of the cervical spine/neck physical exam?

Answer 17

Perform one specialty test

Question 18

What are you looking for when performing the Roos test?

Answer 18

• Have patient, while sitting, abduct shoulders to 90 degrees and flex elbow to 90 degrees in the coronal plane
• Then you have patient open and close fist repeatedly for up to 3 minutes
• (+) test occurs when patient experiences reproduction of symptoms (pain and paresthesia)
• Positive test indicates thoracic outlet syndrome, specifically compression of subclavian artery