HOWTRAININGMATERIAL2010/11 SESSION3

Theneck
Clinicalassessment

A)History
commonsymptomsofneckdisorderarepainandstiffness.
Painreferredtotheshouldersorarms.suddenly(aswithanacuteintervertebraldisc
prolapse)
gradually(asinchronicdiscdegeneration)
Stiffnessintermittent/continuous.
Deformitywryneck/neckfixedinflexion.
Numbness,tinglingandweaknessintheupperlimbsduetopressureonanerveroot;
weaknessinthelowerlimbsmayresultfromcordcompressionintheneck.
Headachesometimesemanatesfromtheneck,butifthisistheonlysymptom,other
causesshouldbesuspected.

B)Examination
Theentireuppertrunkandbothupperlmbsshouldbeexposed.
whenpatientstanding:examineneckpostureandmovements,shoulder.
Whenpatientseated:examineanteriorstructures(trachea,thyroid,oesophagus).
Whenpatientlyingdown:pronefeelformusclespasmandpointtenderness(neck
supportedbyapillow).
SupineNeurologicalexamination.
Lookdeformity.Skinblemishes,scapularabnormilitiesormuscularasymmetry(seen
fromback).musclewastinginthearmorhand.
Feelneckandshoulderspalpatedfortenderareas,lumpsandmusclespasm.
Move
Flexion,extension,lateralflexion,rotationandtherangeofmovements.Shoulder
movements.
Neurologicalexaminationoftheupperlimbsinallcases,sometimes,thelowerlimbs.
Imaging
xrayexaminationfromthebaseoftheocciputtoTI.
a)APviewshouldshowtheregular,undulatingoutlineofthelateral
masses
symmetrymaybedisturbedbydestructivelesionsorfractures.
Aprojectionthroughthemouthisrequiredtoshowtheuppertwo
vertebrae.
b)lateralview,discspacesareinspected;discspacenarrowingand
osteophyteformationattheanteriorandposterioredgesofthevertebral
bodiesarefeaturesofintervertebraldiscdegeneration.
c)Flexionandextensionviewsarerequiredtodemonstrateinstability.
CTandMRIareessentialfordefiningtheintervertebraldiscs,theneuralstructuresand
theoutlinesofthespinalcanalandintervertebralforamina.