Cervical Spine - Assessment Flashcards
Assessment of the Cervical Spine
Upper Cervical and Cervical snapshot:
- Flexion = ?
- Extension = ?
- Side-bend = ?
- Rotation = ?
- Loose & Close pack = ?
- Capsular pattern = ?
Assessment of the Cervical Spine
Cervical Surface Anatomy
External Occipital Protuberance = Midline bump superior to patient’s hairline
Superior Nuchal Line = Lateral to the External Occipital Protuberance
Mastoid = Directly under patient’s earlobes
C1 Transverse Process = Halfway between Mastoid and Mandible, Deep to SCM
C2 Spinous Process = First spinous process inferior to occiput, Bifid – may feel asymmetrical
Facet Joints (Articular Pillar) = Posterior-lateral slope of hexagonal neck, bamboo feel
C6 and C7 Spinous Processes = Extend the spine, C6 translates ant first, followed by C7
T1 does not move
Assessment of the Cervical Spine
Thoracic Surface Anatomy
First Rib = Width of the mastoid at the base of the neck
Spinous Processes =
- T1 – Found in Cervical Palpation
- T3 – Spine of Scapula
- T7 – Inferior Angle of Scapula
Transverse Processes and Ribs = “Finger Rule” and Narrowing Width
- T1-2 – 1 Finger
- T3-4 – 2 Fingers
- T5-8 – 3 Fingers
- T9-10 – 2 Fingers
- T11-12 – 1 Finger
2nd Rib = Highest accessible rib from anterior
Assessment of the Cervical Spine
Canadian C-Spine Rules
Fracture Screening
Canadian C-Spine Rules = Applies to Traumatic MOI
- Sensitivity = 90
- Specificity = 77
Referral and Imaging
- Radiographs have poor Sensitivity
- Miss up to 20% of Cervical Fractures
- CT is preferable
Assessment of the Cervical Spine
Cervical Artery Dysfunction Screening:
- Vertebral vs. Carotid
- Ischemic vs. Non-ischemic
(A) Vertebral
Ischemic
- Dizziness
- Diplopia
- Dysarthria
- Dysphagia
- Drop attacks
- Ataxia
- Nausea
- Nystagmus
- Facial numbness
- Cognitive change
- Photophobia
Non-ischemic
- Ipsilateral posteriuor head/neck pain
(B) Carotid
Ischemic
- Transient ischemic attack (TIA)
- Ischemic stroke
Non-ischemic
- Unfamiliar head/neck pain
- Horner’s syndrome
- Pulsatile tinnitus
Cervical Arterial Dissection
- Younger than 55 y.o
- No Specific Test – Emergent Situation
Vertebrobasilar Insufficiency
- Older than 55 y.o
- Test with Prolonged Rotation, Min 10 Seconds
Assessment of the Cervical Spine
Alar Ligament Screening
Assessment
- Test is considered (+) if the SpP does not immediately move to the contralateral side of the side bending motion.
Assessment of the Cervical Spine
Transverse Ligament Screening
Assessment of the Cervical Spine
Cervical Side-bend ROM
Patient:
- Sitting in neutral
Stabilization:
- None
Testing Motion:
- Palpate spinous processes of C7 and T1
- Instruct patient to laterally flex the nexk to the end ROM
- End ROM = when T1 moves
- Have patient hold that position
- Measure difference between beginning and end positions
End-Feel:
- Firm
Goniometer Landmarks:
- Stationary arm = Perpendicular to floor or table
- Axis of rotation = Spinous Process of C7
- Movement arm = Bisecting the Cranium vertically
Normal ROM
- 0-45 degrees
Assessment of the Cervical Spine
Cervical Flexion MMT (0-5)
Rectus Capitis Anterior:
- O: Anterior tubercles of transverse process of atlas
- I: Occipital bone to the foramen magnum
- In: Ventral rami C1, C2
Rectus Capitis Lateralis:
- O: Superior surface of transverse process of atlas
- I: Inferior surface of jugular process of occipital bone
- In: Ventral rami C1, C2
Longus Capitis:
- O: Anterior tubercles of transverse processes of C3-C6
- I: Basilar process of occipital bone
- In: Ventral rami C1, C2, C3
Longus Colli:
O:
- Superior oblique = anterior tubercles of the transverse processes of C3, C4, C5
- Medial = Vertebral bodies of C5-T3
- Inferior oblique = Vertebral bodies of T1, T2, T3
I:
- Superior oblique = Anterior arch of atlas
- Medial = Vertebral bodies of C2, C3, C4
- Inferior oblique = Anterior tubercles of transverse processes of C5, C6
In: Ventral rami C2-C6
Assessment of the Cervical Spine
Upper Extremity Reflex Testing:
- C5 = ?
- C6 = ?
- C7 = ?
- C1-4 = ?
- Cord = ?
- Jaw Jerk = ?
Assessment of the Cervical Spine
Upper Extremity Sensory Testing:
- C2-T2 = ?
- C2 = Suboccipital
- C3 = Subclavicular Fossa
- C4 = Upper Trapezius
- C5 = Lateral Antecubital Fossa
- C6 = Dorsal or Palmar Surface of Thumb
- C7 = Dorsal or Palmar Surface of 3rd Digit
- C8 = Dorsal or Palmar Surface of 5th Digit
- T1 = Medial Antecubital Fossa
- T2 =Medial Upper Arm
Assessment of the Cervical Spine
Prone C2-C3 PAIVM
Passive Accessory Cervical Mobility - Joint Play
Assessment of the Cervical Spine
Side-Glide PAIVM
Passive Accessory Cervical Mobility - Joint Play
Side-Glide PAIVM (Segmental Mobility)
Client Position:
Supine with head at top of table.
Clinician Position:
Standing at head of table facing client.
Movement and Direction of Force:
Anterior radial aspect of the MCP joint of index finger, clinician purchases the articular pillar of the segment to be tested. The clinician will move to the side being assessed, keeping forearms in line with direction being assessed, extend the wrist and gently cup their hands around client neck (no pressure). The clinician side glides the segment to the opposite direction, adding a little tilt at the end of the movement. In side gliding to the left, the clinician checks for movement down and back on the right and up and forward on the left.
Assessment:
Assessment is done for joint play / passive accessory motion, client response, and end feel. Reproduction of concordant pain suggests dysfunction. Impaired joint mobility or end-feel may also suggest dysfunction if concordant pain is also reproduced.
- The side glide is named for the direction the head moves.
- The left side glide is relatively the same as right side bending.
- Restricted side-glide movement either invvolves ipsilateral restricted down and back (posterior and inferior) movement or contralateral restricted iup and forward (anterior and superior) movement.
Assessment of the Cervical Spine
Thoracic Spine Central PA Mobilization
Passive Accessory Thoracic Mobility - Joint Play
Assessment of the Cervical Spine
Median Neural Tension Test
ULNT 1: Median Nerve Bias
Special Test
Assessment of the Cervical Spine
Radial Neural Tension Test
ULNT 2B: Radial Nerve
Special Test
Assessment
A (+) test is defined by the following criteria:
- Reproduction of client’s symptoms
- Side-to-side differences (reproduces concordant pain on involved side and nonconcordant symptoms on noninvolved).
Assessment of the Cervical Spine
Ulnar Neural Tension Test
ULNT 3: Ulnar Nerve
Special Test
Assessment of the Cervical Spine
Thoracic Compression Fracture:
Closed-Fist Percussion Sign
Special Test
Assessment of the Cervical Spine
Cord Compression:
Lhermitte’s Sign
Special Test
Movement:
The clinician introduces lower cervical flexion.
Assessment:
A (+) test is production of an elextrical-type response or sensation of pins and needles near the end of motion.
