Neck and C Spine Exam Flashcards
anterior triangle
mandible SCM midline
posterior triangle
SCM trapezius clavicle omohyoid crosses lower portion
flexion - chin to chest
45‐90°
SCM, scalene, prevertebral muscles
extension
70‐90°
Splenius capitus, splenius cervicis, intrinsic spinal muscles
rotation
70‐90°
SCM, intrinsic spinal muscles
SB
20‐45°
Scalenes, intrinsics
thyroid exam
- To locate, use cues from visual inspection. Isthmus overlies
2nd‐4th tracheal rings. Have pt flex neck slightly to relax SCMs.
Place fingers of both hands on pt’s neck so that index fingers
just below cricoid cartilage. Have pt swallow so thyroid rises
up under finger pads. - Displace trachea to right and palpate right lobe. Repeat for
left lobe. Anterior surface of a lateral lobe is approx. the size
of the distal phalanx of thumb and feels somewhat rubbery. - If enlarged, listen over lateral lobes to detect bruit which may
be heard in hyperthyroidism. - Findings:
a. Goiters‐Simple (non‐nodular) or multinodular
b. Graves’ disease – soft
c. Hashimoto’s thyroiditis and malignancy – firm
d. Thyroiditis‐tenderness
mm strength C1
resisted R ROM
mm strength C2-4
scapular elevation
mm strength C5
shoulder AB deltoid m
mm strength C6
elbow flexion (biceps) wrist extension
mm strength C7
elbow extension (triceps) wrist flexion
mm strength C8
finger flexion
mm strength T1
finger AB
C1-C4
lesser occipital
greater auricular
cervical cutaneous
C4
superior shoulder/lateral neck
C5
Lateral upper arm (over deltoid)
C6
lateral forearm
C7
middle finger
C8
Right/little finger, medial wrist and forearm
T1
Medial elbow and upper arm
biceps reflex
C5
brachioradialis
C6
triceps
C7
Compression test & Spurling’s
maneuver – Seated or supine
Compression can cause increased pain by narrowing the neural
(intervertebral) foramen, pressure on the facets, or initiating muscle spasm
Compression test – with head and neck in neutral position add an
axial loading force caudally looking for upper extremity pain,
paresthesias, or numbness
Spurling’s – Tests nerve root compression/irritation. Tested with
axial force in neutral, then extension, then SB/rotation toward;
test of high specificity
(+) test = Reproduction of symptoms (pain/neurological symptoms in
distribution of nerve root)
Neck Distraction Test - Seated or
supine
Relief of pain with cervical distraction, opposite of compression test
Doctor places one hand under the
patient’s chin & places the other hand
around the occiput.The doctor
slowly distracts the head.
(+) test= alleviation of symptoms
indicating central compression or central neuropathy
valsalva test
Pt. holds breath and bears down. (+) test = increased pain/paresthesia, especially in nerve root distribution.
Valsalva
↑intrathecal pressure. In presence of space occupying
lesion in cervical canal, this pressure may cause pain in cervical
spine as well as radiation of pain to dermatomal distribution.
thoracic outlet boundaries
Boundaries = 1st ribs, 1st thoracic vertebra, manubrium
Thoracic duct passes through fascial diaphragm twice (left side); Rt
lymphatic duct drains body’s right upper quadrant
Broken into vasculogenic & neurogenic
Structures: brachial plexus, subclavian v, subclavian a
Best thought of as 3 possible zones: scalene triangle, costoclavicular
space, retropectoralis minor
Roos or EAST Test
Compression of subclavian a.
Abduct shoulder to 90° & externally rotate with elbow flexed to 90°;
Doc instructs pt to open & close fist for up to 3 minutes
(+) = reproduction of symptoms (incr pain at shoulder & down arm,
paresthesia, arm pallor, cyanosis and swelling)
Adson Test
Neurovascular bundle (specifically subclavian artery) compressed by
tight scalene muscles or 1st rib
Locate radial pulse on affected arm. Pt breathes deeply. Doc
abducts, extends & ext rotates the shoulder while palpating the
radial pulse. Head is extended & rotated toward affected side.
(Looking towards dysfunctional side‐1st rib etiology)
Then the pt’s head is extended & rotated away from affected side.
(looking away from dysfunctional side‐tight scalene muscles).
(+)= loss or change in pulse, reproduction of symptoms
(+) test indicates compression of subclavian artery between scalenes,
cervical rib, or 1st rib
Wright’s Hyperabduction Test
NV bundle compressed by tight pectoralis minor
Doc locates and monitors the radial pulse on the affected side.The
patient is seated. Stand behind the patient and palpate the radial
pulse with one hand. Abduct the patient’s arm above his or her
head with some extension.
(+)= loss or change in pulse; exacerbation of pain/paresthesia
(reproduction of symptoms)
(+) test indicates neurovascular entrapment by pectoralis minor
muscle
Costoclavicular Test
Extend shoulder and caudal pressure on shoulder noting change in
radial pulse – NV bundle compressed by clavicle and rib 1
Pt seated with Doc behind pt.Contact the ipsilateral wrist at the
radial pulse, extend the shoulder, with elbow extended and wrist
supinated and apply caudal pressure on the shoulder
(+)= decrease in radial pulse
(+) test indicates thoracic outlet synd due to decrease space
between rib 1 & clavicle
nuchal rigidity
(+) test = Marked neck stiffness/resistance to flexion
Found in 57‐92% cases of acute bacterial meningitis, and 21‐86%
of subarachnoid hemorrhage
brudzinski’s
(+) test = flexion in both hips and knees
Low sensitivity, specificity data limited.
subluxation
w/o fracture
dislocation
w/ or w/o neurologic injury
fracture
w/ or w/o neurologic injury
flexion injury
anterior subluxation wedge tx
extension injury
C1, hangaman’s fx (C2) teardrops fx
axial compression injury
jefferson fx (C1)
motor vehicle accident
C1 most common, also C5, C6, C7
falls and sports injuries
C5, C6, C7
clay shovelers’
C6 and C7
jefferson fracture
C1 burst fracture (axial compression injury)
Dens fracture
C2 odontoid fracture at junction of process & body
Often requires surgery
hangman’s fracture
Hyperextension
Bilateral arch fracture, unstable
spinous process fracture
Hyperextension or avulsion force from muscle contraction
Clay Shovelers’ fx – C6 or C7
teardrop fracture
Fracture & dislocation
Flexion & compression injury
Anterior‐inferior teardrop fragment: unstable
wedge fracture
Compression, flexion loading force
burst fracture
Comminuted (ex. Diving injury)
Can result in severe spinal cord injury
anterior subluxation
facet dislocation without fracture
Flexion injury
Unilateral or bilateral facet dislocation
