Cervical Scan

Question 1

Why should you perform a cervical scan?

Answer 1

1. Insidious onset of neck, scapula, shoulder, elbow, or hand pain. (Most common reason)
2. Any symptoms appearing to have neurological component.
3. Any reports of weakness and/or fatigue in the UE
4. Observable muscle atrophy in any muscle innervated by cervical nerve roots
5. Feelings of coldness in one or both hands.
6. Symptom relief from putting arm in unusual positions.
7. Any time progress isn’t what you think it should be (did you miss something?)

Question 2

What are you observing when you start your cervical scan?

Answer 2

Posture, shoulder height, orientation of head, and scapular position

Question 3

Explain how to do the combined movement for ipsilateral SB and rotation for flexion.

Answer 3

Have pt. flex, SB, and rotate to same side (looking towards armpit). Apply compression through the long axis of the neck.

Question 4

What are you checking for with combined movement for flexion?

Answer 4

Screen for significant disc protrusion. Ipsilateral side: compressed, Contralateral side: distracted. Positive test would be radiating down the contralateral shoulder past the AC joint.

Question 5

Ipsilateral SB and rotation in extension

Answer 5

Have pt. extend, rotate, and ipsilaterally SB. Compression is given through long axis of neck.

Question 6

What are you checking for with combined movement for extension?

Answer 6

Intervertebral foramen are at their smallest diameter here. This test checks the patency of the foramen. Positive test is pain radiating down ipsilateral shoulder past AC joint.

Question 7

What is the difference in an irritable facet joint and a positive combined moevements test?

Answer 7

Irritable facet joint will produce pain with this test, but the pain will be in the side of the neck or in the shoulder blade region.

Question 8

What are you assessing with compression tests?

Answer 8

Status of WB surfaces on facet joint for possible fx following history of trauma. Do in flexion and neutral, NEVER in extension.

Question 9

List the two responses you can have from a traction test.

Answer 9

1. Pain increased- ligamentous or muscular structural involvement.
2. Pain decreased- indicates pressure being taken off disc or nerve root.
   Do in flexion, neutral, and extension to find most comfortable.

Question 10

Why would you do traction in supine instead of sitting?

Answer 10

For patients who have difficulty relaxing in seated may be able to relax in supine.

Question 11

How long and hard do you hold when testing myotomes?

Answer 11

Hold for about 10 seconds to check fatigue. You are not trying to overpower them, so match their contraction. This has a high specificity but low sensitivity so correlate with findings.

Question 12

What is the C1-C3 myotome?

Answer 12

Upper Cervical Flexors

Question 13

What muscles are in the C4 myotome?

Answer 13

Levator scapula and Diaphragm

Question 14

The C5 myotome controls what movements?

Answer 14

GH ABD and ER

Question 15

What movements are controlled by C6?

Answer 15

Forearm supination, Elbow flexion and wrist extension

Question 16

C7 controls what motions?

Answer 16

Elbow extension and wrist flexion

Question 17

Where in the hand is the C8 myotome? The T1/T2?

Answer 17

C8: Thumb IP extension

T1/T2: 4th and 5th digit ADD and ABD

Question 18

Name the areas you would test the C4 and C5 reflex.

Answer 18

C4: Levator Scapula (looking for dimple)
C5: Anterior Deltoid (looking for dimple)

Question 19

Where would you test the reflexes for C5-C6 and C6 alone?

Answer 19

C5-C6: Brachioradialis

C6: Biceps

Question 20

What myotome correlates with the triceps muscle?

Answer 20

C7

Question 21

What are the two reflexes dealing with fingers?

Answer 21

C8: Extensor Pollicus Longus
T1: Abductor Digiti Minimi

Question 22

Shoulder depression, shoulder in 110 degrees ABD, forearm supination with wrist and finger extension. Which ULTT test is this and what would you add?

Answer 22

Median nerve test #1.

Have pt. SB toward and away from shoulder being tested.

Question 23

Describe the difference between the first and second Median Nerve ULTT.

Answer 23

2nd has the same components except the shoulder is ABD to 10 degrees instead of 110.

Question 24

Describe the Radial Nerve ULTT.

Answer 24

Shoulder depressed and then ABD to 10 degrees. IR whole arm while putting wrist and thumbs in flexion and ulnar deviation. Extend elbow to end range.

Question 25

Give the steps to the Ulnar nerve dominant ULTT.

Answer 25

1. Shoulder depression
2. Shoulder ABD
3. Wrist extension and forearm supination
4. Full elbow flexion.