Lecture 4: Neck and Cervical Spine Exam

Question 1

Articulation between C2 and C3 and rest of cervical joints (C3-C7) is considered?

Answer 1

Typical

Question 2

What are contraindication for HVLA in the cervical region?

Answer 2

• Rheumatoid Arthritis (weak odontoid ligament)
• Down Syndrome (weak odontoid lig or incomplete/missing odontoid process)
• PVD or risk thereof
• Osteoporosis or risks thereof
• Pt’s on Anticoagulants (shear stress –> intracranial bleed)

Question 3

The C6 dermatome covers what area?

Answer 3

• Lateral forearm and thumb

Question 4

What spinal nerves innervate the diaphragm and respiratory paralysis may result from spinal cord injury above which cervical vertebrae?

Answer 4

• C3, C4, C5 “keeps the diaphragm alive”
• Injuries above C5

Question 5

What are the sensory dermatomes for the neck and clavicle area?

Answer 5

C3-C5

Question 6

What are the sensory dermatomes for the nipples and umbilicus?

Answer 6

T4 = nipples

T10 = umbilicus

Question 7

Reflex testing for the: C4-5 disc, C5-6 disc, and C6-7 disc; what root is tested for each and the corresponding muscle?

Answer 7

C4-5 disc = C5 root - Biceps

C5-6 disc = C6 root - Brachioradialis

C6-7 disc = C7 root - Triceps

Question 8

A sensory exam for C4, C5, C6, C7, C8, and T1 corresponds to which regions?

Answer 8

C4 = lateral neck

C5 = lateral upper arm

C6 = lateral forearm and thumb

C7 = middle finger

C8 = medial wrist/forearm

T1 = medial elbow/upper arm

Question 9

How do we do strength testing for C1, C2-4, C5, C6, C7, C8, and T1?

Answer 9

C1 = resisted rotation ROM

C2-4 = scapular elevation

C5 = deltoid, should ABduction

C6 = biceps, wrist ext.

C7 = triceps, wrist flex.

C8 = finger flex

T1 = finger ABduction

Question 10

When do we check ROM in a trauma patient w/ neck pain?

Answer 10

Do NOT check ROM of the neck until you have cleared the neck either clinically or radiographically

Question 11

What is a very important historical or clinical statement when it comes to the cervical spine; why??

Answer 11

• Neck stiffness (inability or unwillingness) to move the neck is concerning
• Found in majority of cases of acute bacterial meningitis and subarachnoid hemorrhage

Question 12

Cervical fractures all require what; and what must be determined?

Answer 12

• All require at least neurosurgical consultation
• Must determine if stable or unstable

Question 13

What are Atraumatic causes of neck pain?

Answer 13

• Cervical strain
• Myofascial injury
• Degenerative (i.e., Spondylolysis)
• Torticollis
• Meningitis

Question 14

What is the most common cause of acute or chronic neck pain?

Answer 14

Cervical Spondylosis

• Degenerative bony lesions
• Degenerative disc disease
• Osteophyte formation

Question 15

What is Adult Torticollis?

Answer 15

• Acquired (maybe slept the wrong way)
• Typically result from SCM or Trapezius muscle injury or inflammation
• May be caused by wide variety of conditions due to muscle spasm or cervical nerve irritation

Question 16

Kernig’s vs. Brudzinski’s sign?

Answer 16

Kerning’s sign: inability or reluctance to allow full ext. of the knee when the hip is flexed 90 degrees

Brudzinski’s sign: spontaneous flexion of the hips during attempted passive flexion of the neck

*Tests for meningitis or sub-arachnoid hemorrhage*

Question 17

What is it called if pt has normal plain films and CT of the cervical spine but continues to have neurologic signs or symptoms; most commonly seen in?

Answer 17

• Spinal cord injury without radiographic abnormality (SCIWORA)
• More common in peds and geriatric pts

Question 18

What is the most common cause of atraumatic neck pain?

Answer 18

Degenerative disease

Question 19

What are Non-spinal causes of Neck pain?

Answer 19

• Thoracic outlet syndrome
• Herpes Zoster
• Diabetic Neuropathy

Question 20

What is Cervical Radiculopathy; what symptoms seen; most common cause?

Answer 20

• Compression/dysfunction of spinal nerve root
• Pain, weakness, reflex changes, or sensory changes
• Most commonly caused by degenerative changes in spine

Question 21

What is leading cause of death for young adults worldwide?

Answer 21

MVC’s

Question 22

What are the Nexus Criteria; what are they used to determine; what are the rules?

Answer 22

• Determine which patients presenting w/ neck pain after trauma need radiographic imaging
• If all criteria are met the patient does not need any imaging
• If all criteria are not met apply a cervical collar and image the patient

Question 23

When do we apply cervica immobilization?

Answer 23

If you are unable to clear your trauma patient with neck pain clinically, you must immobilize their cervical spine until they can be cleared radiographically

Question 24

If using a plain film X-ray for imaging after traumatic neck pain what must be seen; practically how is the C-spine typically cleared, radiographically?

Answer 24

• Must have an acceptable view of odontoid
• Must see through the top of T1 on lateral
• Most fractures will be seen on odontoid and lateral views

*Practically, most people clear the C-spine radiographically w/ CT

Question 25

How to properly perform spinal immobilization?

Answer 25

• Person stabilizing the neck is captain of the team
• Pt should NOT make ANY effort on the rolling process

Question 26

What are some criteria for performing radiographic imaging in patiens with Non-Traumatic Neck pain?

Answer 26

• Age >50 years w/ new symptoms
• Constitutional symptoms (fevers, chills, unexplained weight loss)
• Moderate-to-severe neck pain lasting more than 6 weeks
• Progressive neurological findings
• Infections risk (i.e., injection drug use, immunosuppression)
• History of malignancy

Question 27

What should be the first-line imaging study performed in patients with progressive signs or symptoms of neurologic disease?

Answer 27

MRI