Cervical Spine (Week 4)

Question 1

What are the signs and symptoms of cervical instability?

Answer 1

• Severe muscle spasm
• Reluctance to move head, especially into flexion
• Lump in throat
• Lip or facial paresthesia
• Severe headaches
• Dizziness, nausea, vomiting
• Soft end feel
• Nystagmus
• Pupil changes

Question 2

What is the purpose of the Sharp-Purser Test?

Answer 2

To determine subluxation of the atlas on the axis, indicating a possible transverse ligament tear.

Question 3

What is the procedure for the Sharp-Purser Test?

Answer 3

1. Therapist places one hand on the patient’s forehead and the thumb of the other hand over the spinous process of the axis to stabilize.
2. Patient is asked to slowly flex the head.
3. Therapist applies backward pressure with the palm as the patient flexes.

Question 4

What indicates a positive Sharp-Purser Test?

Answer 4

• Therapist feels the head slide backward.
• May hear a “clunk” sound.

Question 5

What are the implications of a positive Sharp-Purser Test?

Answer 5

• A transverse ligament tear may allow the odontoid process to shift relative to C1’s anterior arch.
• The patient may show apprehension during forward flexion in functional testing due to subluxation.

Question 6

What is the purpose of the Transverse Ligament Stress Test?

Answer 6

To evaluate the integrity of the transverse ligament between C1 and C2.

Question 7

What is the procedure for the Transverse Ligament Stress Test?

Answer 7

1. Patient lies supine.
2. Therapist supports the occiput with the palms and 3rd, 4th, and 5th fingers.
3. Index fingers are placed in the space between the occiput and C2 SP, overlying C1’s neural arch.
4. Head and C1 are lifted anteriorly together without allowing flexion or extension.
5. Hold position for 10-20 seconds.

Question 8

What indicates a positive Transverse Ligament Stress Test?

Answer 8

• Soft end feel
• Muscle spasm, dizziness, nausea
• Paresthesia of the lip, face, or limbs
• Nystagmus
• Lump sensation in the throat

Question 9

What are the implications of a positive Transverse Ligament Stress Test?

Answer 9

1. The transverse ligament prevents anterior shear of C1.
   • A positive test suggests hypermobility at the atlanto-axial (A-A) articulation.

Question 10

What is the grading scale used for muscle strength tests?

Answer 10

The Oxford Manual Muscle Testing Scale (0-5) is used.

Question 11

What do different types of muscle weakness indicate during strength tests?

Answer 11

• Weakness without pain suggests a neurological problem.
• Weakness with pain suggests a moderate to severe muscle strain.

Question 12

What is the procedure for testing the anterior neck flexors?

Answer 12

1. Patient is supine with elbows bent, hands overhead (90/90), and thorax and pelvis fixed on the table.
2. Patient flexes the cervical spine by lifting the head from the table, chin depressed toward the sternum.
3. Therapist applies posterior pressure against the forehead.

Question 13

What muscles are involved in the anterior neck flexors test?

Answer 13

Longus capitis, longus colli, and rectus capitis anterior.

Question 14

What is the procedure for testing the anterolateral neck flexors?

Answer 14

1. Patient is supine with elbows bent and hands beside the head, resting on the table (90/90).
2. Patient performs anterolateral neck flexion (contralateral rotation and flexion).
3. Therapist applies obliquely posterior pressure against the temporal region of the head.

Question 15

What muscles are involved in the anterolateral neck flexors test?

Answer 15

SCM (sternocleidomastoid) and scalenes.

Question 16

What is the procedure for testing the posterolateral neck extensors?

Answer 16

1. Patient is prone with elbows bent and hands overhead, resting on the table.
2. Patient performs posterolateral neck extension with ipsilateral rotation.
3. Therapist applies anterolateral pressure against the posterolateral aspect of the head.

Question 17

What muscles are involved in the posterolateral neck extensors test?

Answer 17

Splenius capitis/cervicis, semispinalis capitis/cervicis, and cervical erector spinae.

Question 18

What is the procedure for testing the upper trapezius?

Answer 18

1. Patient is high-seated.
2. Therapist places the patient into cervical extension, contralateral rotation, and ipsilateral shoulder elevation.
3. Therapist applies pressure against the shoulder in the direction of depression and against the head in the direction of anterolateral flexion.

Question 19

What is the procedure for testing the levator scapulae?

Answer 19

1. Patient is prone with the arm by their side and elbow fully flexed (like a “chicken wing”).
2. Head is turned to the testing side.
3. Therapist applies pressure to depress the scapula (pressing inferiorly at the acromion) and attempts to upwardly rotate the scapula by pressing superiorly at the elbow.

Question 20

What is the grading scale used for muscle strength tests?

Answer 20

The Oxford Manual Muscle Testing Scale (0-5) is used.

Question 21

What do different types of muscle weakness indicate during strength tests?

Answer 21

• Weakness without pain suggests a neurological problem.
• Weakness with pain suggests a moderate to severe muscle strain.

Question 22

What is the procedure for testing the anterior neck flexors?

Answer 22

1. Patient is supine with elbows bent, hands overhead (90/90), and thorax and pelvis fixed on the table.
2. Patient flexes the cervical spine by lifting the head from the table, chin depressed toward the sternum.
3. Therapist applies posterior pressure against the forehead.

Question 23

What muscles are involved in the anterior neck flexors test?

Answer 23

Longus capitis, longus colli, and rectus capitis anterior.

Question 24

What is the procedure for testing the anterolateral neck flexors?

Answer 24

1. Patient is supine with elbows bent and hands beside the head, resting on the table (90/90).
2. Patient performs anterolateral neck flexion (contralateral rotation and flexion).
3. Therapist applies obliquely posterior pressure against the temporal region of the head.

Question 25

What muscles are involved in the anterolateral neck flexors test?

Answer 25

SCM (sternocleidomastoid) and scalenes.

Question 26

What is the procedure for testing the posterolateral neck extensors?

Answer 26

1. Patient is prone with elbows bent and hands overhead, resting on the table.
2. Patient performs posterolateral neck extension with ipsilateral rotation.
3. Therapist applies anterolateral pressure against the posterolateral aspect of the head.

Question 27

What muscles are involved in the posterolateral neck extensors test?

Answer 27

Splenius capitis/cervicis, semispinalis capitis/cervicis, and cervical erector spinae.

Question 28

What is the procedure for testing the upper trapezius?

Answer 28

1. Patient is high-seated.
2. Therapist places the patient into cervical extension, contralateral rotation, and ipsilateral shoulder elevation.
3. Therapist applies pressure against the shoulder in the direction of depression and against the head in the direction of anterolateral flexion.

Question 29

What is the procedure for testing the levator scapulae?

Answer 29

1. Patient is prone with the arm by their side and elbow fully flexed (like a “chicken wing”).
2. Head is turned to the testing side.
3. Therapist applies pressure to depress the scapula (pressing inferiorly at the acromion) and attempts to upwardly rotate the scapula by pressing superiorly at the elbow.