EEPT: CERVICAL REGION

Red Flags
Red Flags Cervical Neoplastic Upper Vertebral Inflammatory Cervical
Myelopathy Conditions Cervical Artery or Systemic Fracture
Ligamentous Insufficiency Disease
Instability
Signs & • Sensory • Age >50 years. • Occipital • Drop attacks. • Temperature • Trauma
Symptoms disturbances of • Previous headache and • Dizziness >100 Degrees F
the hands. history of numbness. • Dysphasia • BP >160/95
• Hand intrinsic cancer. • Severe • Dysarthria mmHg
muscle testing. • Unexplained limitation • Diplopia • Resting Pulse
• Unsteady gait. weight loss. during neck • (+) Cranial >100 bpm
• Hoffman’s • Constant pain, active range of nerve signs. • Resting
reflex. not relieved motion • Ataxia respiration >25
• Babinski with bed rest. (AROM) in all • Nausea bpm
• Clonus • Night pain. directions. • Fatigue
• Inverted • Signs of
supinator sign cervical
• Hyperreflexia myopathy.
• Bowel and • Post trauma.
bladder • Rheumatoid
disturbances. Arthritis
• Multisegmental • Down
weakness. syndrome
• Multisegmental
sensory
changes.

Yellow Flags
• Pain is harmful or disabling
• Pain must be eliminated before returning to activity
• Passive attitudes towards therapy
• Patient utilization of extended rest, reduced activity level and withdrawal from daily
activities
• Patient reports of extreme pain intensity
• High intake of alcohol or other substances

Palpation
Supine
• Palpate bilateral sternoclavicular joints for mobility assessment or tenderness.
• Palpate acromioclavicular joint for mobility assessment or tenderness.
• Palpate sub-occipital muscles, upper trapezius, levator scapula, and pectoralis minor to
assess shortness or tenderness.
Prone
• Central and peripheral Cervical and Thoracic Spine.
• Palpate ribs 1 - 7 of the upper and mid thoracic region.
• Ribs 1 - 7 posterior to anterior accessory motion.
Seated
• Palpate for tissue texture changes down medial groove of cervical and thoracic spine.
• Palpate for tissue texture changes on either side of the spinous processes of the cervical
and thoracic spine.
• Palpate for any scoliotic deviations.

 EEPT: CERVICAL REGION

Reflexes
• C5 - C6 – biceps
• C5 – C6 – brachioradialis
• C7 – triceps

Manual Muscle Testing

• Elbow
◦ Flexion (C5,C6)
◦ Extension (C7)
• Shoulder
◦ Flexion (C5)
◦ Extension (C6, C7, C8)
◦ Abduction (C5)
• Wrist
◦ Flexion (C6 – 7)
◦ Extension (C6 – 7)
• Finger
◦ Flexion (C7 – C8)
◦ Extension (C7 – C8
◦ Abduction (T1)

Sensory Examination
• C3 – Occiput
• C4 – Supraclavicular space
• C5 – Anterior shoulder
• C6 – Lateral shoulder
• C7 – Posterior arm
• C8 – Phalanxes 4 – 5
• T1 – Medial arm and axilla

Special Tests
• Cranial Cervical Flexion Test
• Neck Flexor Muscle Endurance Test
• Upper Limb Tension Test (ULTT)
• Spurling’s Test
• Distraction Test
• Valsalva Test

 EEPT: CERVICAL REGION

Differential Diagnosis
1. Are the patient’s symptoms reflective of a visceral disorder or a serious or potentially life-
threatening illness? This may indicate non-mechanical conditions such as:
◦ Cervical Myelopathy
◦ Cervical Instability
◦ Fracture
◦ Neoplastic Conditions
◦ Vascular Compromise
◦ Systemic / Visceral Disease

 EEPT: CERVICAL REGION

OTHER SPECIAL TESTS: