Cervical Spine

Question 1

C-Spine question (to determine if need imaging

Answer 1

1. Are they cognitively intact?
2. Are they under 65 y/o?
3. They can move more than 45d Rot (even if it causes pain)?
4. No crazy injury circumstance (distraction based/high speeds, etc.)
5. No pain at rest in midline?
6. No Paresthesia in arms following trauma.

Question 2

Tests for upper cervical instability?

Answer 2

modified sharp purser
alar lig stress test
transverse lig of atlas test

Question 3

S&S of upper cervical instability?

Answer 3

Severe Muscle Spasms
Resistance and apprehension to movement (especially flexion)

Lump in throat
Lip or facial paresthesia
Severe HA
Dizziness, Nausea, vomiting, nystagmus, pupillary changes, or any other VBI indications

SOFT END FEEL (empty or spongy end feel)

Question 4

Describe Modified Sharp Purser Test? Examining what structure? What are positive S&S?

Answer 4

Stabilize C2 spinous process, and push forehead posteriorly. Actually reduces compressionof cord!
+ S&S= cluck, relief of symptoms
examines transverse lig
ALways perform with Down’s and RA pt (ligamentous laxity)

Question 5

Describe Transverse Ligament Test of Atlas. Structure tested and + S&S?

Same name as Anterior Shear or Sagittal Stress Test?

Answer 5

Obviously examines transverse ligament. Performed by supine, and use fingers on C1 transverse processes to anteriorly shear C1 on C2. Hold 15-20 sec. THen slight head flexion using shoulder.
Opposite of modified sharp purser.
Positive S&S= parethesia, soft end-feel, VBI symptoms (nystagmus, diplopia, pupil changes, nausea), lump in throat

Question 6

Alar Ligament Stress Test

Answer 6

Slightly flex head.
Grasp C2 then side-bend or rotate head
+ if C2 does NOT move in opposite direction within 20-30 degrees of movment

Question 7

Pettman’s Distraction Test

Answer 7

Test longitudinal lig/tectorial membrane
Patient Supine
Fixate axis (C2) with lumbrical grip
Distract occipit until end-feel Neutral spine (some perform with slight flexion) 
Positive:
	 Symptom reproduction
	 > 1 mm distraction

Question 8

Atlantoaxial Lateral Shear Test

tests for odontoid dysplasia?

Answer 8

Key fob grip
both hands push together or transverse processes
+ if vestibular symptoms (nystagmus, pupillary changes, dizziness, soft end feel, nausea, facial or lip paresthesia, lump sensation in throat)

Question 9

Jefferson’s Fracture/Odontoid Fracture Test

Answer 9

Stabilize head by holding ociput
Medially shear C1
+ if increased translation of C1 lateral mass

Question 10

Myotomes for UE

Answer 10

C1-C2 neck flexion
C3 side flexion
C4 shoulder elevation
C5 shoulder abduction
C6 elbow flexion, wrist extension
C7 elbow extension, wrist flexion
C8 UD and thump extension
T1 hand extrinsic/ opposition?

Question 11

If pt has problem with flexing neck, what muscles/myotome involved?

Answer 11

C1-C2

rectus capitus, rectus longis, longi coli, SCM

Question 12

If pt has problem flexing elbow or extending wrist, what muscles/myotome involved?

Answer 12

C6
SA, Lat dorsi, subscapularis, teres major, biceps, coracobrachialis, brachioradialis, ext carpi radialis longus, scalenes

Question 13

If problem with shrugging shoulder? what muscle/myotome?

Answer 13

C4

diapragm, traps, levator scap, scalenes

Question 14

if problem with side bending of neck, what muscles/myotome?

Answer 14

C3

longus capitus, trap, scalene med, levator scapula

Question 15

If problem with laterally raising arm, what muscles/myotome?

Answer 15

C5

rhomboids, deltoid, supraspinatus, infraspinatus, biceps

Question 16

If problem with hand movments, what muscles/myotome?

Answer 16

T1
flex dig profunsus
flex pollicis brevis
oppones pollicus

Question 17

If problem with ext elbow and flex wrist, what muscles/myotome?

Answer 17

C7

SA, lat dorsi, pectoralis, tricpes, ext carpi rad longus, ext digitorum

Question 18

If problem with thumb ext & UD, what muscles/myotome?

Answer 18

C8

pronator, flex dig profundis, flex carpi radialis, ext pollicus

Question 19

What reflexes could be affected if Cervical Involvement?

Answer 19

Biceps (C5, C6)
Brachioradialis (C6)
Triceps (C7, C8)
Hoffmann sign (if upper motor lesion suspected). Flicking the fingernail of middle or ring finger and flexion of thumb is seen)

Question 20

trigger point location for Supraspinatus

Answer 20

deltoid mostly

can radiate to lateral epicondyle of elbow

Question 21

trigger point location for infraspinatus

Answer 21

deltoid, bicep region, into radial forearm and thumb, index and middle finger
Median N distribution (C6)

Question 22

Deltoid trigger point location

Answer 22

mostly deltoid

posterior shoulder/triceps

Question 23

trap trigger point referral

Answer 23

temple region (ram horn)
occiput region
spinous processes C6-T1

Question 24

biceps trigger point referral

Answer 24

bicep distribution

Question 25

latissmus dorsi trigger point referral

Answer 25

lower lat

then post. arm (radial distribution)

Question 26

coracobrachialis trigger point referral

Answer 26

triceps, delt, post. forearm

Question 27

special tests should do either 1 of 2 things

Answer 27

provoke symptoms

relieve symptoms

Question 28

describe Spurling’s Compression Test

Answer 28

Provocation Test
perform in neutral first
then with side bending (to uninvolved before involved)

Question 29

Jackson’s Compression Test

Answer 29

same as Spurling’s but with rotation

+ is pain radiates into arm

Question 30

Maximal Foraminal Compression Test (Spurling’s Upper/Lower Quadrant)

Answer 30

For Upper
- with protraction
For Lower quadrant sign
- extension, ipsilateral side bend and rotation

Question 31

Distraction Test

Answer 31

+ if radicular S&S present

+ if pn relieved/decreased

Question 32

Criteria for Cervical Radiculopathy

Answer 32

Positive SPurling's
Positive if relieve w/ distraction
less than 65 deg rot
Positive if median N ULNT 
90% specificity if all 4
65% if 3 present

Question 33

Bakody’s Sign

Answer 33

SHoulder abduction relieft

C4-C6

Question 34

ULNT 1

Answer 34

median N

Question 35

ULNT 2

Answer 35

median N

Question 36

ULNT 3

Answer 36

radial N

Question 37

ULNT 4

Answer 37

ulnar N