Neck and Cervical Spine Examination

Question 1

What is the primary motion of the OA joint?

Answer 1

flexion and extension

-modified type I mechanics

Question 2

What is the primary motion of the AA joint?

Answer 2

rotation

-atlas rotates around the dens of C2

Question 3

What do we look for upon normal observation of the neck?

Answer 3

lordosis
distended jugular vein
masses or goiters
tracheal deviation

Question 4

How do you observe the thyroid?

Answer 4

tip pt’s head back
locate thyroid and cricoid cartilage
inspect region below cricoid cartilage for gland
pt swallows: observe for symmetry and contour

Question 5

What is the anterior triangle?

Answer 5

mandible, SCM, midline

Question 6

what is the posterior triangle?

Answer 6

SCM, trapezius, clavicle

Question 7

Where do we check for lymph nodes for this region?

Answer 7

occipital, pre and post auricular, submandibular, submental, tonsilar, and supraclavicular

Question 8

How do you palpate the thyroid?

Answer 8

have pt flex neck to relax SCMs
place fingers below cricoid cartilage,
have pt swallow
use thumbs to displace trachea and palpate each lobe
if enlarged, listen over lateral lobes to detect bruit (hyperthyroidism)

Question 9

What are some findings for the thyroid palpation?

Answer 9

Goiters
graves disease: soft
hashimoto’s thyroiditis: firm
thyroiditis: tenderness

Question 10

Where does a cervical nerve root exit the spinal column?

Answer 10

it exits ABOVE the numbered vertebra

Question 11

Name the muscle strength tests for each spinal nerve C1-T1

Answer 11

C1 is turning the head
C2-4 is scapular elevation
C5 is shoulder abduction
C6 is elbow flexion
C7 is elbow extension
C8 is finger flexion
T1 is finger abduction

Question 12

Name all of the sensory exam dermatomes for C1-T1

Answer 12

C1-4 is behind the head region
C4 is superior shoulder
C5 is lateral upper arm
C6 is lateral forearm
C7 is middle finger
C8 is medial wrist and forearm
T1 is medial elbow and upper arm

Question 13

Name the DTR’s for this region

Answer 13

C5 is biceps
C6 is Brachioradialis
C7 is triceps

Question 14

What is spurling’s test?

Answer 14

compress the head down in neutral and then in extension, then sb/rotation toward dysfunction to be more specific
-+ if reproduction of symptoms (pain in distriubtion of nerve root)

Question 15

What is the neck distraction test?

Answer 15

when there is releif of pain with cervical distration, it’s positive
-it’s just the opposite of the spurlings test

Question 16

What is the valsalva test?

Answer 16

pt holds breath and bears down

-+ if increased pain or paresthesia, expecially in nerve root distribution

Question 17

What are the thoracic outlet boundaries?

Answer 17

1st ribs, 1st thoracic vertebra, and the manubrium

brachial plexus, sublavian a. and v. are there

Question 18

What is ROOS or EAST test?

Answer 18

make them quack like a duck for 3 minutes with their hands

+ if repro of symptoms

Question 19

What is Adson Test?

Answer 19

abduct, extend, and ext rotate the shoulder while palpating the radial pulse, head is extended and rotated toward affected side, then the pts’ head is extended and rotated away from affected side
+ if loss or change in pulse, repro of symptoms
indicates compression of sublaviand a. between SCALENES, CERVICAL RIB, OR 1ST RIB

Question 20

What is Wright’s hyperabduction test?

Answer 20

NV bundles compressed by tight pectoralis minor
-doc locates radial pulse on affected side, stand behind the pt and palpate the radial pulse with one hand, abduct the patients arm above his head with some extension
+if loss or change in pulse, pain, paresthesia
indicates NV entrapment by pec minor

Question 21

What is the costoclavicular test?

Answer 21

extend shoulder and caudal pressure on shuolder noting change in radial pulse
-monitor radial pulse, extend the shoulder, with elbow extended and wrist supinated and apply caudal pressure on the shoulder
+ if decrease in radial pulse
indicates thoracic outlet synd due to decrease space between rib 1 and the clavicle

Question 22

Nuchal rigidity

Answer 22

+ marked neck stiffness, found in a lot of bacterial meningitis cases

Question 23

Brudzinski’s sign

Answer 23

+ if we see flexion in both hips and knees

-both of those test for inflammation in the subarachnoid space

Question 24

What is subluxation?

Answer 24

facet dislocation

Question 25

What is a wedge fracture?

Answer 25

compression from hyperflexion injury

-all of the front stuff is messed up

Question 26

What is a jefferson fracture?

Answer 26

compression fracture of the bony ring of C1

-occurs by axial blow to the vertex of the head (diving injury)

Question 27

What is a hangman’s fracture?

Answer 27

hyperextension, bilateral arch fracture, unstable

Question 28

What is a teardrop fracture?

Answer 28

fracture and dislocation