Welcome

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 Md. Jahidul Islam
B. Sc in Physiotherapy
4th year
Roll- 19
Session: 2016-17

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Clinical Examination of
Neck Pain According to
Cyriax

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In clinical examination we are mainly looking for-

 Articular signs
 Root signs
 Cord signs
 Alternative cause for arm pain

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 History
• Age
• Pain:
-How pain started?
-When felt pain?
-Where the pain is located?
• Pain progression
• Recurrence
• Paresthesia
• Vertigo
• Medication
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 Inspection
Posture (In sitting, standing)
In slouched position body has this certain consequences:
 Lower cervical flexion and upper cervical extension
 Protruded head position
 Lumbar and thoracic flexion.

Cervical curvature analysis

***[Between the age of 40-60 years there is significant loss of retraction movement.,
for this we advice regular active retraction exercise]
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 Neck Movement
Active ROM:

Extension
Flexion
Rotation
Side flexion

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 Cont..
We asses pain presence at which ROM.

We expect to find-
-Partial Articular Pattern(PAP) in case of internal derangement.
-Full Articular Pattern(FAP) in case of arthritis, arthrosis.

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 Neck Movement

Passive ROM:

Extension
Rotation
Side flexion

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 Cont..
 In passive ROM we asses Pain ,ROM, End feel and Vertigo

***[A muscle spasm or a bone to bone end feel provide a strong

contradiction to manipulation]

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 Neck Movement
Resisted test:

Flexion
Extension
Rotation
Side flexion

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 Cont..
 In resisted test we asses pain and strength.

The rotation is a test for C1 nerve root.

In case of occipital muscle lesion, resisted extension will be painful.

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 Shoulder Shrugging
 Active: In active shoulder
shrugging we asses-
Pain
ROM
Paresthesia

 Resisted: This is a test for the

C2,C3,C4 nerve roots.

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 Active Bilateral Arm Elevation
 This is a quick test for shoulder girdle.
We can detect some pathologies-

Mononeuritis
Fracture at 1st rib, spinous process
Painful Arc
Limitation at the glenohumeral joint

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Nerve Root Examination

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Motor function test for upper
limb

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Fig: Shoulder abduction (C5 Involvement)

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Fig: Shoulder Lateral Rotation(C5)
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Fig: Elbow flexion(C5-C6)
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Fig: Wrist extension(C6)

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Fig :Elbow extension(c7)

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Fig: wrist flexion (C7)

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Fig: Thumb extension(C8)

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Fig: Little finger abduction(T1)

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Sensory Function test

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Reflex test

Fig: Biceps reflex (c5-c6)

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 Cont..

Fig: Brachioradialis reflex(c5)

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 Cont..

Fig: Triceps reflex(c7)

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 Planter reflex

 An important test for the spinal

cord.

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 Cont..

***[A positive Babinski is an absolute contraindication for manipulative

treatment]

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Any Questions??

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Thank You…

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Reference
• Cyriax J H,Cyriax P J 1993, Cyriax's Illustrated Manual of Orthopedic
Medicine, 6th edn Butterworth-Heineman, Boston, Oxford

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