ASSESSMENT OF

CERVICAL SPINE

BY: KHUSHALI JOGANI

The Sarvajanik College Of Physiotherapy
Rampura,Surat
Contents:

 Introduction
 Patient history
 Observation
 Palpation
 Examination of movement
 Special tests
 Diagnostic imaging
 References
 INTRODUCTION
 Cervical spine consists of 37 joints.
 It has been said that cervical spine moves 600 times
per hour with normal activity.
 An area where stability is sacrificed for mobility.
 Divided into two areas: 1)cervicoencephalic
2)cervicobrachial
 Lordotic curve in cervical region develops at 3 to 4
months of age as child lifts head.
 At C4 to C5 interspace there is midpoint of curve.
 Line of gravity falls anterior to foramen magnum
 Abnormality from normal lordotic curve leads to
following:
 Reduction in cervical lordosis

 Increase in cervical lordosis

Resting position: slight extension

Closed packed position: full extension

Capsular pattern: side flexion and rotation equally

limited,extension
PATIENT HISTORY
 Age and gender
 Occupation
 Address
 Dominant side and affected side
 Chief complaint
 Mechanism of injury
 Onset of problem
 Location of Pain or other symptom when it
started
 Activities causing pain
 Duration and frequency of symptoms
 Has this occurred before and if so with what it
relieved ?
 Are the intensity,duration frequency increasing?
 Is pain periodic, episodic,occasional?
 Is pain associated with rest,activity,postures?
 Did the head strike to anything?
 Radiation of pain?
 Is pain affected by laughing, coughing, sneezing?
 Does the patient have headache,where, frequency
and does any position changes it?
 Is paraesthesia present?
 Tingling or numbness (unilateral or bilateral)?
 Any lower limb symptoms or difficulty in walking
or balance?
 Quality of pain and site and boundaries of pain?
 Is the condition improving? Worsening? Staying
the same?
 Activities aggravating or easing?
 Restriction of movement?
 Is there any difficulty in swallowing or voice
changes?
 Sleeping position and type of pillow?
 Any functional losses?
 Dizziness?
 Medical history
 Drug history
 Surgical history
 Economic history
 Social history
 Pain history
-VA Scale
-Mc Gill –Melzack pain questionnaire
-Thermometer pain rating scale
OBSERVATION
 Body built
 Assistive device
 Attitude of limb
 Posture( standing and sitting)
lateral
anterior
posterior
 Muscle spasm or any asymmetry?
 Facial expression?
 Any Trophic changes?
PALPATION
 Tenderness
 Trigger points
 Any muscle spasm or swelling?
 Texture of skin and bony and soft tissues
-posterior
-anterior
-lateral
EXAMINATION
 Range of motion tests
 Active movements to be checked
-flexion, extension, rotation(right &left), side
flexion(right & left)
-combined movement
-repetitive movement
-sustained position
 Overpressure applied to check end feel
 Normal end feel is tissue stretch(all motions)
Tools used are
-Goniometer
-CROM
-Inclinometer
 Functional OA ROM
 Functional AA ROM
 Resisted isometric movements
 Peripheral joint scan
Active range & overpressure
-TM joint
-scapula
-Shoulder joint
-elbow joint
-wrist & hand
 MMT
-cervical muscles
 -scapular muscles
 Myotomes (if weakness is due to neurological
involvement)
-neck flexion: C1-C2
-neck side flexion:C3
-shoulder elevation: C4
-shoulder abduction/shoulder lateral rotation: C5
-elbow flexion and/or wrist extension:C6
-elbow extension and/or wrist flexion:C7
-thumb extension and/or ulnar deviation:C8
-abduction and/or adduction of hand intrinsic:T1
 Sensory examination
Using light touch and pin prick on the
dermatomal levels on both ride and left side.
 Reflex evaluation
-biceps jerk(C5-C6)
-triceps jerk(C7)
-brachioradialis jerk(C6)
-jaw jerk
-hoffmann’s sign( if UMN suspected)
 Functional assessment
-activities of daily living
-functional strength testing
 If tightness is suspected muscle length test
should be done.
 Checking for locking maneuver and quadrant
position for shoulder .
SPECIAL TESTS

 Common test done in cervical spine are:

-foraminal compression test(spurling’s test)
-distraction test
-upper limb tension test
-shoulder abduction test
-vertebral artery (cervical quadrant) test
 Craniocervical flexion test
 Thoracic inlet syndrome test
-adson’s test
-costoclavicular
-hyperabduction
-3 min elevated arm exercise
DIAGNOSTIC IMAGING

 Plain film radiography

-lateral view
-open or odontoid view
-oblique view
 CT Scan
 MRI
REFERENCES
 Orthopaedic physical therapy
-DONNATELLI WOODEN (third edition)
 Orthopaedic physical assessment
-DAVID J.MAGEE(fifth edition)
 Orthopaedic examination, evaluation,&
intervention
-MARK DUTTON