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