Cervical Examination

Question 1

History of cervical injury

Answer 1

• past history of neck pain
• dizziness/light headedness
• pain
• paresthesia
• numbness
• weakness
• stiffness

Question 2

Quality of symptoms for cervical injury

Answer 2

• sharp
• dull
• stabbing
• ache
• electric shock like

Question 3

Red flags for cervical spine injury

Answer 3

• severe loss of ROM with sudden onset
• changes in balance/gait
• hypo/hyper reflexia
• constant pain
• severe radiating pain
• moderate to severe occipital headache
• facial pain
• psychological changes
• cranial nerve symptoms
• dizziness
• Horner syndrome
• hemiparesthia
• bowel & bladder changes
• ataxia
• nystagmus (rapid involuntary movement of the eyes)
• drop attacks
• hemifacial parathesia
• dysphagia

Question 4

History suggesting cervical spondylosis (arthritis)

Answer 4

• age >45
• most commonly affected levels C5, C6, & C7
• slow gradual onset
• unilateral pain
• pain radiates into specific dermatomes
• pain increases with extension & decreases with flexion

Question 5

History suggesting disc involvement

Answer 5

• age <60
• most commonly effects C5 & C6
• sudden onset
• unilateral
• symptoms radiate into a dermatome
• tingling present
• pain increases with flexion

Question 6

History suggesting instability

Answer 6

• traumatic MOI unless they have RA
• complaint of nonspecific symptoms that are worse in vertical & better with head support

Question 7

Self assessments for the cervical spine

Answer 7

• Neck Disability Index (NDI)
• Patient specific functional scale
• Fear avoidance beliefs questionnaire

Question 8

Special tests for upper cervical instability

Answer 8

• Sharp Purser: chin tuck increases symptoms and pushing C1 back onto C2 relieves symptoms

Question 9

Special tests for vertebral artery

Answer 9

• Hautant: arms out close eyes hold for 10 secs then same thing but look off to the side and up
• Cervical quadrant test: supine eyes open and passively move patient head into extension, side bending, & rotation hold 30 secs
• Pre-manipulative position test

Question 10

Symptoms of vertebral artery insufficiency

Answer 10

• dizziness/vertigo
• nausea/vomiting
• inability to stand
• blurred vision/diplopia
• headache
• facial paresthesia/facial palsy/difficulty swallowing

Question 11

Describe deep cervical flexion test/cranial cervical flexion test

Answer 11

• patient supine in hook lying with head/neck in midrange
• pump up BP cuff to 20 mmhg or to fill their lordosis
• have patient perform chin tuck in five increments increasing by 2 each time holding for 10 secs and resting for 10 secs between
• normal is 26-30 mmhg hold for 10 secs without SCM substitution

Question 12

Describe neck flexor muscle endurance test

Answer 12

• patient supine in hook lying
• chin maximally retracted & maintained isometrically as head is held 1 inch above the table
• normal is 38 secs

Question 13

What is the order for ULTT-A (AKA median nerve tension test)

Answer 13

• scapular depression
• forearm supination
• wrist and finger extension
• shoulder ER
• elbow extension
• shoulder abduction
• side bend away

Question 14

Describe the different cervical glides

Answer 14

• Central PA: pushing through the spinous process
• Unilateral PA: pushing through the facet joint on one side
• Transverse: side bending at the facet performed in supine

Question 15

Describe pain with compression findings

Answer 15

• disc
• vertebral body fracture
• nerve root irritation (radiating)
• flexion can target disc & vertebral body
• extension can target nerve root & facet joint

Question 16

Describe decreased pain with distraction

Answer 16

• disc
• spinal facet
• nerve root (centralizing)

Question 17

Test item cluster for cervical spine radiculopathy

Answer 17

• ULTT-A
• Spurling’s
• Distraction
• Cervical rotation <60 degrees to ipsilateral side

Question 18

Describe the shoulder abduction test

Answer 18

• patient seated & asked to place arm to rest over their head
• test for radiculopathy

Question 19

Describe TMJ screen

Answer 19

• open & close mouth while looking for deviation, pain, and/or clicking
• lateral glide pain, clicking, or asymmetrical movements

Question 20

Exam findings for neck pain with mobility deficits

Answer 20

• recent onset
• absence of referred symptoms
• restricted ROM in rotation and/or side bending
• restricted cervical & thoracic segmental mobility
• low NDI (<11.5)
• bilateral movement pattern involvement
• better when moving neck
• neck extension does not worsen symptoms
• medical diagnosis of spondylosis without radiculopathy

Question 21

Intervention focus for neck pain with mobility deficits

Answer 21

• spinal mobilization/manipulation
• AROM exercises

Question 22

Exam findings for neck pain with radiating pain

Answer 22

• radicular/referred symptoms in the UE
• peripheralization and/or centralization of symptoms with ROM
• signs of nerve root compression present
• medical diagnosis of cervical radiculopathy

Question 23

Intervention focus for neck pain with radiating pain

Answer 23

• mechanical/manual cervical traction
• repeated movements to centralize symptoms
• manual therapy
• home exercise program of cervical spine retraction & deep cervical flexor training

Question 24

Test item cluster for improvement with 3 weeks mechanical traction

Answer 24

• age >55
• pos. shoulder abduction test
• pos. ULTT-A
• symptom peripheralization with central PA
• pos. neck distraction test

Question 25

Exam findings for neck pain with coordination deficits

Answer 25

- lower pain & disability scores - longer duration of symptoms - no signs of nerve root compression - no peripheralization/centralization during ROM

Question 26

Intervention focus for neck pain with coordination deficits

Answer 26

- strengthening & endurance exercises for the muscles of the neck and UE - aerobic conditioning exercises

Question 27

Exam findings for neck pain with headache

Answer 27

- unilateral headache with onset preceded by or associated with neck pain - cervical AROM (can exacerbate HA) - cervical/thoracic segmental mobility (can exacerbate HA) - cranial cervical flexion test (can exacerbate HA)

Question 28

Intervention focus for neck pain with headache

Answer 28

- spinal manipulation/mobilization - deep cervical flexor training - soft tissue/muscle trigger point treatment - postural education & training

Question 29

Exam findings for neck pain

Answer 29

- high pain & disability scores - recent onset of symptoms - traumatic onset - may have referred pain in shoulder - poor tolerance to exam and/or interventions - medical diagnosis may be whiplash associated disorder

Question 30

Intervention focus for neck pain

Answer 30

- gentle AROM as tolerated - ROM for adjacent regions - modalities - activity modification