Neck and Cervical Spine Exam Competency

Question 1

What are the different C-Spine routes and which muscles are they testing for muscle strength?

Answer 1

C1: Resist rotation ROM (Main nerve is XII)
C2-C4: Scapular Elevation
C5: Deltoid, Shoulder Abduction
C6: Biceps, wrist Extension
C7: Triceps, wrist Flexion
C8: Finger Flexion
T1: Finger Abduction

Question 2

What are the nerves and roots that we are concerned with when giving a Sensory Exam to the Neck?

Answer 2

C1-4: Lesser Occipital, Greater Auricular, and Cervical Cutaneous Ns.

C4: Lateral Neck
C5: Lateral Upper Arm
C6: Lateral Forearm
C7: Middle Finger
C8: Medial wrist/forearm
T1: Medial elbow/upper arm

Question 3

Define Compression Neuropathy.

Answer 3

Nerve entrapment by muscular/myofascial tissue (Pain and decrease strength)

Can be due to Vertebral Foramen being narrow; Thoracic Outlet Syndrome

Question 4

What are the Special Test for Compression Neuropathies in the C-Spine? (3)

Answer 4

1. Compression (causes) / Distraction (relieves pain) Test
2. Spurling’s Test: SB/Sidebending toward affected side, then add axial compression
3. Valsalva: Increase or reproduction of pain

Question 5

What are the Special Tests for Thoracic Outlet Syndrome?

Answer 5

1. Adson’s Test: Subclavian A. Compression
   - Monitor RADIAL Pulse
   - ABduction, Extension, External Rotation of Upper Extremity
   - Take a Breath, then turn to affected side and then turn to the other side
   - Looking for reproduction of symptoms or LOSS of pulse
2. Roos/EAST (Elevated Arm Stress Test)
   - Subclavian A. Compression
   - Abduct and Externally Rotate to 90 and flex arm to 90
   - Open and close hands looking for reproduction of symptoms
3. Wright’s Test
   - Subclavian A. Impingement (PEC MINOR)
   - Monitor RADIAL A. and ABduct arm all the way up to 180 degree
4. Costoclavicular Test
   - Compression at Clavicle
   - Extend the should and monitor for RADIAL pulse

Question 6

What are the boundaries of the Thoracic Outlet?

Answer 6

1st Rib
1st Thoracic Vertebra
Manubrium

Question 7

What are the three possible zones where you could have compression in Thoracic Outlet Syndrome?

Answer 7

1. Scalene Triangle
2. Costoclavicular Space
3. Retropectoralis Minor

Question 8

What Special Tests can indicate Meningitis and/or Subarachnoid Hemorrhage?

Answer 8

1. Nuchal Rigidity Test
   - Stiffness/Resistance to Flexion
2. Brudzinski’s
   - Flex patient’s neck and their HIPS and KNEES flex too (Positive Test)

Question 9

What are the most commonly injured C-Spine features in Motor Vehicle Accidents vs. Athletics?

Answer 9

MVAs: C1

Athletics: C5, C6, C7