Cervical Spine Examination and Treatment

Question 1

Canadian C-Spine Rules

Answer 1

1. Are they cognitively intact?
2. Are they under 65 y/o?
3. They can move more than 45 degrees rotation?
4. No crazy injury circumstances?
5. No pain at rest in midline?
6. No paresthesia in arms?
   - If YES, no X-Ray needed

Question 2

When to start observing patients?

Answer 2

As soon as they enter examination room

Question 3

Signs and Symptoms of Cervical Ligamentous Instability?

Answer 3

• Severe muscle spasms
• Resistance and apprehension to movement
• Lump in throat
• Lip or facial paraesthesia
• Severe headache
• Dizziness, nausea, vomiting, nystagmus, and pupillary changes
• Empty/spongy end feel

Question 4

Modified Sharp-Purser Test

Answer 4

• Patients head slightly flexed
• Hold C2 and forehead and push towards each other
• Feel for clunk and relief of symptoms
• Test for TRANSVERSE LIGAMENT

Question 5

Transverse Ligament Test

Answer 5

• Supine position
• Apply an anterior force to the transverse processes of C1
• Should push dens into spinal cord and cause symptoms

Question 6

Anterior Shear or Sagittal Stress Test

Answer 6

• Supine position
• Thumbs placed over axis and fingers over the atlas
• Force between the fingers and thumbs
• Positive test is production of symptoms

Question 7

Alar Ligament Stress Test

Answer 7

• Sitting position with slight flexion
• Hold C2 with pincer grip
• Side-bending or rotation
• Should feel movement under grasp

Question 8

Longitudinal Ligament Test

Answer 8

• Supine
• Grasp C2
• Distract occiput until end-feel
• Positive more than 1mm of distraction

Question 9

Ligaments We Test

Answer 9

• Atlanto-Occipital Ligament - Joint capsule thin and loose
• Anterior A-O Membrane - Foramen magnum to C1 - Limits vertical displacement
• Posterior A-O Membrane - C1 to occiput - Limits vertical displacement

Question 10

Atlantoaxial Lateral Shear Test

Answer 10

• Supine
• Key fob grip on C1 transverse process and grip on transverse process of C2
• Force between grips
• Positive test is reproduction of symptoms

Question 11

Jefferson’s Fracture/Odontoid Fracture Test

Answer 11

• Supine
• One hand under occiput other hand on lateral mass of atlas
• Apply medially directed force on atlas
• Positive test is increased translation of lateral mass

Question 12

Vascular “Clearing” Tests

Answer 12

• Important part of assessment

- Does decrease risk of complications when doing end-range mobs and manipulation

Question 13

Vertebral Artery Test

Answer 13

• Sitting
• Rotation, Extension, Side-bending to one side
• Held for 10-30 seconds
• Positive is 5 Ds A 3 Ns

Question 14

ROM Screening

Answer 14

• UC Flexion
• ## UC Extension

Question 15

Nodding vs. Flexion

Answer 15

• Nodding is UC flexion

- Flexion occurs in lower cervical