Examination of spine

Cervical region

Spine

• 33 bones

• 24 mobile individual segments– 7 cervical– 12 thoracic– 5 lumbar

• 2 lordotic 1 kyphotic

• Vertebral foramen

• Costal process

Anatomy of vertebra

• Body• 2 pedicles• 2 sup facets• 2 inf facets• Trans process• Lamina• Spinous process• Cord - canal

Relation of various parts of body

Anatomy of cervical spine

Ligaments of spine

Strap muscles of neck

Muscles of cervical spine

1. Semispinalis Capitus

2. Iliocostalis Cervicis

3. Longissimus Cervicus

4. Longissimus Capitus

Problems

• Strain & Sprain

• Ivdp

• Facet artropathy

• Infection– Septic– Tuberculous

• Vascular

History

• When/how• Intensity• Diurnal variation• Movements• Deglutation• Vomiting• Trauma • Constitutional symptoms

Neurological history

• Pain first/weakness first• Progression• Sensory• Motor• ADL affected• Tight/loose• Clonus• Jerky movements• Locomotion/list

Examination

• Look

• Touch

• Move

• Measure

Inspection

• Posterior– Inion– Vertebra prominens– Muscle spasm– Both shoulders– Scapula– Interscapular region

Anterior

• C3 – hyoid

• C4-5 - thyroid cartilage

• C6 – cricoid cartilage

• Sternum

• Notch

Palpation

• Bone– Spinous process

– Transverse process

– Hyoid

– Cricoid Ring

– Inion

– Scapula

• ROM • Flexion (80 to 90o)• Extension (70o)• Lateral flexion (L & R) (20 to 45o)• Rotation (L & R) (70 to 90o)• Shoulder elevation & depression

• PROM– Tissue stretch end feel for all

Examination

– Flexion• Scalenes• Longus coli

– Extension• Levator scapulae• Trapezius• Splenius, semispinalis, & longissimus cervicis

Examination

– Lateral flexion• Trapezius• Longus capitus• Sternocleidomastoid

– Rotation• Levator scapulae• Sternocleidomastoid

– Shoulder elevation

Sternomastoid

Extension strength

Flexion strength

Lateral flexion

Examination

• Peripheral joint scanning– TMJ– Shoulder girdle– Elbow– Wrist and hand

Special Tests

• Vertebral Artery Test

• Distraction

• Compression

• Valsalva Test

• Swallowing/cough

• Adson Test

• Spurling’s Sign (Foraminal Compression)

• Grip Strength

• Wiggle Fingers and Toes

• Pinch/Reaction to Pain

Vertebral Artery Test• With patient supine,

examiner supports pt’s head in both hands

• Examiner slowly extends, rotates, & laterally flexes pt’s head to the L then R.

• Hold each position for 30 sec

• Dizziness, blurred vision or slurred speech indicates complete or partial occlusion of vertebral artery

Distraction Test• Examiner begins by placing the

open palm of one hand under the pt’s chin with the other hand on the occipital bone at the base of the skull

• Gentle, linear, traction-like pressure is then exerted to lift pt’s head

• Positive test yields a relief of pain

• May be indicative of nerve root compression

Compression Test• Examiner presses down on the

crown of the pt’s head, looking for

apprehension or signs of pain

• Pt should be either seated or supine

• Positive test yields pain upon

compression and

• indicative of narrowed neural

foramen causing nerve root

compression

Spurling’s test

• Extend neck

• Rotate it to involved side

• Complains of pain

• Indicative of nerve root compression

Lhermite’s sign

• Flex c-spine and thoracic spine

• Parasthesia on trunk/limbs

Valsalva Maneuver

• The examiner should instruct the pt to “bear down” as if performing a bowel movement

• This movement increases interthecal pressure and is positive if pain is felt upon performance

• May be indicative of a herniated disc

Swallowing/Cough

• Pain upon swallowing or coughing is considered a positive test that may be indicative of cervical spine pathology or soft tissue swelling

Adson Test• Examiner begins by palpating the pt’s

radial pulse• Pt’s arm is then abducted, extended, and

externally rotated while the examiner continues to palpate the pulse

• Pt is instructed to take a deep breath and turn the head toward the arm (look “AD” me) being tested

• A disappearance of the radial pulse is a positive test that indicates a compression of the subclavian artery by the medial scalene muscle

Wiggle Fingers & Toes

The examiner instructs the patient to quickly flex and extend the fingers and toes.

Test is positive if athlete is unable to perform task and may indicate motor nerve involvement

Cervical spinal stenosis

• UMN below lesion level

• LMN above lesion level

Neurologic Exam: Sensory

C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of

shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and index

finger C7: Middle finger and palmar aspect of

hand C8: Small finger, ring finger, and medial

portion of palmar surface T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm

Neurologic Exam: Motor

C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation T1: Finger approximation

Neurologic Exam: Reflexes

Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)

ULT test 1

• C5-7 roots

Upto 1100

Circulatory

• Carotid

• Brachial

• Radial