Cervical Spine

Question 1

Bony Palpation

Answer 1

Anterior Aspect
1) Hyoid Bone
2)Thyroid Cartilage
3) First Cricoid Cartilage
4) Mandible
Posterior Aspect
1) Occiput
2) Inion
3) Superior Nuchal Line
4) Mastoid Processes 
5) Spinous Processes of Cervical Vertebrae 
6) Facet Joints

Question 2

Soft Tissue Palpation

Answer 2

1) Sternocleidomastoid muscle
2) Anterior Lymph Node Chain
3) Posterior Lymph Node Chain
4) Thyroid gland
5) Carotid pulse
6) Supraclavicular fossa
7) Trapezius muscle
8) Greater Occipital Nerve
9) Superior Nuchal Ligament

Question 3

Foraminal Compression Test

Answer 3

Instruct: Patient seated with examiner standing behind. Examiner clasps his/her hands over patient’s head and exerts gradual increasing downward pressure. Examiner repeats this procedure with the patient’s head rotated right and then left.
Positive: 1) Exacerbation of localized cervical pain
2) Exacerbation of cervical pain with a radicular component
Indicates: 1) Foraminal encroachment or facet pathology
w/o nerve root compression
2) Foraminal encroachment or facet pathology w/ nerve root compression

Question 4

Cervical Distraction Test

Answer 4

Instruct: Patient seated: the examiner grasps the patient’s head with both hands and gradually exerts upward pressure keeping hands of TMJ and ears.
Positive: 1) Diminished or absence of localized pain
2) Diminished or absence of radicular pain
3) Increase of cervical pain
Indicates: 1) Foraminal enroachment (local pain diminishes)
2) Nerve root compression (Radicular pain diminishes)
3) Muscular strain, ligamentous sprain, myospasm, facet capsulitis

Question 5

Spinal Percussion Test

Answer 5

Instruct: Patient seated with head in slight flexion, percuss each cervical spinous processes and the associated musculature with the pointed end of a reflex hammer.
Positive: 1) Local pain
2) Radiating pain
Indicates: 1) Possible fractured vertebrae, ligamentous involvement (spinous pain), and muscular involvement (muscular pain)
2) Possible disc pathology

Question 6

Shoulder Depression Test

Answer 6

Instruct: Patient seated, examiner stabilizes patient’s laterally flexed head while pushing down on shoulder
Positive: 1) Localized pain on the side being tested
2) Radicular pain on the side being tested
3) Radicular pain on the the opposite side
Indicates: 1) Dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury.
2) Neurovascular bundle compression, dural sleeve adhesions, or Thoracic Outlet Syndrome.
3) Foraminal encroachment with nerve root compression.

Question 7

Vasalva Maneuver

Answer 7

Instruct: Patient seated, examiner instruct patient to take a deep breath and hold while bearing down as if straining at a bowel movement.
Positive: Radiating pain from site of lesion (usually positive in cervical or lumbar area of the spine)
Indicates: Space occupying lesion (e.g. disc pathology)

Question 8

Swallowing Test

Answer 8

Instruct: Patient seated: examiner instruct the patient to swallow
Positive: Difficulty in swallowing
Indicates: Space-occupying lesion at anterior portion of cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes etc.

Question 9

Soto-Hall Sign

Answer 9

Instruct: Patient supine, examiner flexes patient’s head toward his/her chest while exerting downward pressure on patient’s sternum with hypothenar eminence of inferior hand.
Positive: Generalized pain in the cervical region, which may extend down to the level of T2
Indicates: Non-Specific test for structural integrity of cervical region.

Question 10

Kernig Sign

Answer 10

Instruct: Patient supine, examiner passively flexes patient’s hip to 90 degrees and the patient’s knee to 90 degrees. Examiner extends patient’s leg completely.
Positive: Inability to fully extend the leg and/or pain (usually in the neck region)
Indicates: Meningeal irritation/meningitis

Question 11

O’Donoghue Maneuver

Answer 11

Instruct: Patient is seated, examiner grasps the patient’s head with both hands and passively and slowly takes the cervical region through a range of motion. The examiner then takes the cervical region though isometric contractions.
Positive: 1) Pain during passive range of motion
2) Pain during resisted range of motion
Indicates: 1) Ligamentous sprain (Passive ROM stresses ligaments)
2) Muscle/Tendon strain (Active ROM stresses muscles and tendons)