Basic Clinical Examination for Cervical Spine

Yiannis Sotiralis PT-OMT , MSc Kostas Sakellariou, PT-OMT, MSc

Senior Clinical Instructors
Certified Adults’ Educators
Posture (head,
shoulders, spine in
Inspection
general)
Is there an antalgic
posture?
Breathing pattern

2
Inspection
 Active movements

The pain must be

mechanically induced
(not central etc)
Test upper and lower
cervical spine
We check the movement
pattern of the patient

4
Active movements

Flexion
Extension
Rotation left – right
Sidebending left – right (lift opposite shoulder to differentiate
arthro/myo)
Combined
flexion side bending rotation
extension sidebending rotation
Shoulder elevation - depression
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Active movements

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Active movements
Active movements

8
Active movements

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Active movements combined
Active movements
Passive examination of anatomical movements
Check upper and lower cervical spine

Flexion
Extension
Rotation left and right
Sidebending left and right
Combined
flexion side bending rotation
extension sidebending rotation

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Passive examination of anatomical movements
Passive examination of anatomical movements
Key muscles

Flexion C1-C2
Sidebending C3 & Accessory nerve XI
Shoulder elevation C4 & Accessory nerve XI
Shoulder abduction and external rotation C5
Elbow flexion and/or wrist extension C6
Elbow extension and/or wrist flexion C7
Thumb extension and/or ulnar deviation C8
Adduction and abduction of hand’s intrinsic muscles Th1

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Resisted tests

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 Resisted tests

C3 C4
 Resisted tests

C5
C5 C6
 Resisted tests

C6 C7

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 Resisted tests

C8 T1
Deep tendon reflexes

0: absent reflex
• Biceps C6
1+: trace, or seen only with
reinforcement • Brachioradialis C6
• TricepsC7
2+: normal
• Finger flexors C8
3+: brisk
4+: nonsustained clonus (i.e.,
repetitive vibratory movements)
5+: sustained clonus

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Deep tendon reflexes

C5-6 C6
Deep tendon reflexes

C7 C8
Neurodynamics Median nerve
Neurodynamics Radial nerve
Neurodynamics Ulnar nerve
 Upper limb
Neurodynamics
testing
 Upper limb
Neurodynamics
testing
Security tests

Alar & Apical ligaments - Tectorial membrane

Security tests
Dens integrity
Security tests
Sharp Pursher’s (transverse ligament)
Special tests

Hoffman response

Is elicited by holding the patient's middle finger between the examiner''s thumb and index finger
Patient must relaxe the fingers
The therapist using his thumbnail presses down on the patient's fingernail and moves it downward until
his nail "clicks" over the end of the patient's nail.
Normally, nothing occurs.
A positive Hoffman's response is when the other fingers flex transiently after the "click".
Repeat this maneuver multiple times on both hands.
A positive Hoffman response is indicative of an upper motor neuron lesion affecting the upper extremity
in question.
 Clonus

If any of the reflexes is hyperactive.

Hold the relaxed lower leg in your hand, and sharply dorsiflex the foot and hold
it dorsiflexed.
Feel for oscillations between flexion and extension of the foot indicating clonus.
Normally nothing is felt.
Vertebral artery test
Distraction – Compression (Spurling’s)
Vasalva

Increases intraspinal pressure ➔ pain sometimes

A positive Vasalva may show problems related to disc dysfunction, Dural
tears headaches etc
Passive examination

C0-C1 flexion C0-C1extension

Passive examination

general flexion general extension

Passive examination

General rotation
Passive examination

Extension C0-C1 from right rotation Extension C0-C1 from left rotation
Passive examination

Sidebending C0-C1 from right rotation Sidebending C0-C1 from left rotation
Passive examination
Sidebending C2-C3
Passive examination
Sidebending below C5
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Thank you