Cervical Spine Examination Flashcards
What is the synovial joint between articular processes of the cervical vertebrae?
Facet joint or Zygapophyseal joint
What are the primary movements of the OA joint?
Flexion and extension
What are the primary movements of the AA joint
Rotation
What are the primary movements of C2 - C7
Rotation and sidebending Both occur to the same side
What pulse needs to be assessed and what’s importnat to remember about that pulse?
carotid pulse. Don’t measure both pulsees at once.
How do you measure jugular venous pressure?
patient lying at 30° with pillow under head
turn head away from side of examination
identify IJV using tangential lighting
find the highest point of pulsation an extend a line out horizontally
Centimeters above the sternal angle is the jugular venous pressure
How do you palpate the thyroid?
stand behind pt. have pt flex neck slightly
place fingers below cricoid cartilage
have pt swallow
assess symmetry
What muscles are responsible for flexion?
SCM
Scalenes
Paravertebral muscles
(45° - 90°)
What muscles are repsonsible for extension?
Splenius capitus
splenis cervicis
intrinsic spinal muscles
(70° - 90°)
What muscles are responsible for rotation?
SCM
Intrinsic spinal muscles
(70° - 90°)
What muscles are responsible for sidebending?
Scalenes
Intrinsic spinal muscles
(20° - 45°)
Compression Test (Spurling’s Maneuver)
pt. head in neutral position
Introduce axial load (caudally)
positive test: pain in upper extremity
Diagnosis: central neuropathy
Neck Distraction Test
pt. seated, head neutral.
SD places hand under pt chin
SD places hand around occiput
SD distracts (lifts) the head
Positive Test: neuropathy pain relieved
Diagnosis: central neuropathy
Valsalva Test
pt holds breath and bears down (valsalva maneuver)
as a result intrathecal pressure increases
Positive Test: increased pain/paresthesia in the problematic nerve root
Diagnosis: space occupying lesions (within the cervical canal)
Define Parestheisa
an abnormal sensation, tingling or prickling
what are the boundaries of the thoracic outlet?
1st rib
1st thoracic vertebra
manubrium
what structures run through the thoracic outlet?
brachial plexus
subclavian vein
subclavian artery
thoracic duct
EAST Test (Roos)
pt flexes elbow 90° and external rotates shoulder 90°
pt opens and closes fist for 3 minutes
Positive Test: Reproduction of pain/paresthesia
Diagnosis:
- thoracic outlet syndrome (subclavian a compression)
Adson Test
SD palpates radially pulse
SD abducts, extends, and externally rotates shoulder while maintaining palpatation
pt head extended and rotated towards pulse
Pt head extended and rotated away from pulse
Positive Test: loss/change in pulse or pain/paresthesia
Diagnosis:
- Thoracic Outlet Syndrome (chiefly)
- compression of subclavian artery between scalenes (when looking away)
- compression of subclavian artery between 1st rib (when looking towards)
Wright’s Hyperabduction Test
SD finds radial pulse
Pt arm abducted above head
Positive Test: loss/change in pulse, pain/paresthesia
Diagnosis:
- Thoracic Outlet Syndrome (chiefly)
- neurovascular entrapement by pectoralis minor
Costoclavicular Test (Military/Halstead Test)
SD finds radial pulse
elbow extended and supinated
extend shoulder while SD applies a caudal pressure to the shoulder
Positive Test:
- loss/change in pulse
- pain/paresthesia
Diagnosis:
- Thoracic Outlet Syndrome (chiefly)
- neurovascular entrapement between 1st rib and clavicle
Nuchael Rigidity (Kernig Sign)
pt supine
SD flexes pt neck until chin touches chest
Positive Test: neck stiffness/resistance to flexion
Diagnosis:
- inflammation in subarachnoid space (chiefly)
- meningitis
- subarachnoid hemorrhage
Brudzinski’s Sign
pt supine
SD flexes pt neck until touches chest
Positive Test: flexion in hips and knees
Diagnosis:
- inflammation in subarachnoid space (chiefly)
- meningitis
- subarachnoid hemorrhage
