Cervical Spine Assessment & Treatment

Question 1

When is a neurological exam indicated?

Answer 1

• Patient reports pins & needles or numbness

- Pain past the shoulder

Question 2

What movements are tested for each upper limb myotome?

Answer 2

C1: CSp flexion
C2: CSp extension
C3: CSp lateral flexion
C4: Shoulder shrug
C5: Shoulder abduction
C6: Elbow flexion
C7: Elbow extension
C8: Thumb extension, finger flexion
T1: Finger abduction/adduction

Question 3

What are the upper limb neurodynamic tests?

Answer 3

Upper limb tension tests

1a: Median
2a: Radial
3: Ulnar

Question 4

What is the cervical flexion-rotation test used for?

Answer 4

• Assess dysfunction at the C1-C2 motion segment
• Rotation at this level accounts for 45-50% rotation in cervical spine
• Normal > 44 degrees
• Restricted in patients with cervicogenic headaches

Question 5

What is a positive Spurling’s test?

Answer 5

• Reproduction of arm symptoms

- Indicates nerve root compression

Question 6

What is the diagnostic test cluster that indicates a radiculopathy?

Answer 6

• ULTT 1a
• Cervical rotation <60 degrees
• Distraction test
• Spurling’s test

Question 7

What pathologies are associated with poor deep neck flexor strength?

Answer 7

Cervicogenic headaches, whiplash, chronic neck pain

Question 8

What are the important deep neck flexor muscles?

Answer 8

• Longus capties

- Longus colli

Question 9

What does evidence show about immobilisation in neck pain?

Answer 9

• Use of soft collar, rest, time off work associated with poor recovery
• Better outcomes in the “act as usual” group
• Exceptions: Cervical spine instability or fracture

Question 10

What are the first line treatments for whiplash?

Answer 10

• Reassure & stay active
• Return to usual activities
• ROM, load load isometric endurance & strengthening exercises

Question 11

What treatments are not recommended in acute whiplash?

Answer 11

Not routinely recommended:

• Manual therapy
• Kinesio tapiing
• Acupuncture
• Surgery

Not recommended:

• Reduction of usual activity
• Collars
• Muscle relaxants
• Steroid injections

Question 12

What evidence is there for massage for neck pain?

Answer 12

• May be beneficial if there is excessive tightness or trigger points
• No long term studies so far

Question 13

What is mechanical traction used for?

Answer 13

Relieving nerve root compressions (poor evidence)

Question 14

What are the CIs to mechanical traction?

Answer 14

• Medical red flags
• CNS symptoms
• Hypermobility
• Pregnancy
• RA
• OP
• Infection of spine/bone
• Cancer
• Vascular compromise

Question 15

What are the indications for mobilisations?

Answer 15

Joint pain & dysfunction

Question 16

What are the CIs for mobilisations?

Answer 16

• Acute inflammatory disease
• Infection
• Tumours/cancer
• Arteriosclerosis
• Aneurysms
• DVT
• Spinal cord compromise
• Cauda equina syndrome

Question 17

What are the precautions for mobilisations?

Answer 17

• Neurological changes
• RA
• Ligament laxity
• Pregnancy
• Prolonged use of anticoagulants & corticosteroids

Question 18

What does evidence show regarding exercise for neck pain?

Answer 18

• Strengthening exercises are effective for chronic neck pain, cervicogenic headache & cervical radiculopathy
• Should focus on neck, shoulder & scapula region
• Strengthening exercises should be combined with endurance or stretching exercises (but not endurance or stretching alone)