Cervical Spine Eval

Question 1

Observation

Answer 1

• Observe posture anteriorly:
  ~ Is the head rotated or or shifted to
  one side?
  ~ Are the shoulders level?
• Observe posture laterally:
  ~ Is there forward head posture?
  ~ Is there Thoracic Kyphosis?
  ~ Is there Lumbar Lordosis?
  ~ Is the acromion lined up with the
  ear?
• Observe posture posteriorly:
  ~ Is the head rotated or or shifted to
  one side?
  ~ Are the shoulders level?

Question 2

Palpation

Answer 2

Anterior:
- Hyoid Bone
- Thyroid Cartilage
- Cricoid Cartilage
- Carotid Pulse
- Brachial Plexus
- Erb’s point
- Sternocleidomastoid
- Scalenes
- Upper Traps

Posterior:
- Occiput
- Superior nuchal line
- Ligamentum nuchae
- Spinous processes C2-C7
- Transverse processes C1-7
- Facet joints C1-C7

Question 3

AROM, PROM, RROM

Answer 3

• Flexion
• Extension
• Lateral Flexion
• Rotation

Question 4

Manual Muscle Tests

Answer 4

• Sternocleidomastoid
  ~ Pt. is supine with head rotated to the
  opposite side being tested
  ~ Clinician applies resistance over
  temporal bone
• Longus Capitis
  ~ Pt. is supine in the hook line position
  ~ Pt. tucks chin and lifts head an inch
  from table and maintains position as
  long as possible
• Upper Traps
  ~ Pt. is sitting and shrugs shoulders
  ~ Clinician applies resistance over
  shoulders from behind

Question 5

Tests for Pain or Hypermobility/Hypomobility

Answer 5

• Joint Play
  ~ Pt. is prone with a neutral neck and
  clinician applies posterior to anterior
  pressure to the Spinous Processes
• First Rib Mobility
  ~ Pt. is sitting and the clinician palpates
  the posterior aspect of the first rib
  applying an inferior gliding force

Question 6

Test for hyperirritability of the peripheral nerve

Answer 6

• Upper Limb Tension Test
  ~ Pt. is supine with arm/shoulder off
  table with head laterally flexed away
  ~ Clinician depresses shoulder on tested
  side and holds the following positions
  for 6 seconds:
  > Abduction of shoulder at 90
  degrees
  > External rotation of shoulder and
  elbow flexion at 90 degrees
  > Supination of forearm and
  extension of wrist
  > Extension of elbow

Question 7

Tests for Upper Motor Neuron Lesion

Answer 7

• Babinski Test
  ~ Pt. is supine and clinician runs an
  instrument up the plantar surface of
  foot from medial calcaneus to ball of
  foot
  ~ The toes should curl
  ~ Positive test is indicated by great toe
  extension and other toes splay
• Oppenheim Test
  ~ Pt. is supine and clinician runs
  instrument along the crest of the
  ateromedial tibia
  ~ Positive test is indicated by great toe
  extension and other toes splay or pt.
  reports hyper sensitivity

Question 8

Test for occlusion of the vertebral arteries

Answer 8

• Vertebral Artery Test
  ~ Pt. is supine and clinician holds head
  under occiput while passively
  extending and rotating to one side for
  30 seconds
  ~ Positive test is indicated by dizziness,
  confusion, nystagmus, unilateral pupil
  changes, and nausea

Question 9

Tests for cervical compression or nerve root impingement

Answer 9

• Cervical Compression
  ~ Pt. is seated and clinician applies
  pressure down on head from behind
  ~ Positive test is indicated by pain or
  reproduction of symptoms
• Spurling’s Test
  ~ Pt. is seated while extending and
  laterally flexing head and clinician
  applies compression from behind
  ~ Positive test is indicated by pain or
  reproduction of symptoms
• Cervical Distraction
  ~ Pt. is supine