Cervical Spine Examination

Question 1

Observation

Answer 1

Posture and alignment - protraction or retraction of the cervical spine and elevation or depression of the shoulders
Poking chin
Muscle tension in jaw
Breathing pattern - lateral expansion
Crease lines - increased flexibility
Muscle bulk or atrophy

Question 2

Palpation

Answer 2

Trunk muscles - upper traps, levator scapulae, rhomboid minor and major, erector spinae, lat dorsi
Temperature

Question 3

Active range of motion

Answer 3

Flexion - 60 degrees, chin to chest
Extension - 75 degrees, lift head up
Side flexion - 45 degrees, left and right, ear to their shoulder
Rotation - 80 degrees, left and right, support arms to elevate the shoulders so traps is offloaded
Protraction - 20 degrees, poke chin forwards
Retraction - 15 degrees, bring chin into their head
Add over pressure

Question 4

Dermatome testing

Answer 4

Dermatome - area of skin that is supplied by a single nerve root
Light touch
Sharp vs blunt
Test - circumferentially or Dermatome comparing sides and areas of the limb, cotton wool, feels the same on both sides

Question 5

Myotome testing

Answer 5

Myotome - groups of muscle innervated by a single spinal nerve
C1 - cervical spine flexion
C2 - cervical spine extension
C3 - cervical spine side flexion
C4 - shoulder elevation
C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extension
C8 - thumb extension
T1 - finger adduction and abduction
Isometric resisted movement
Graded on oxford scale
Comparing both sides

Question 6

Reflex testing: biceps tendon

Answer 6

Nerve root of C5/6
Bicep tendon in cubital fossa
Place thumb or fingers over it
With reflex hammer tap over it
A good result is the bicep contracting or seeing the flicker of the tendon

Question 7

Reflex testing: brachioradialis

Answer 7

Nerve root of C6
On patients forearm with their thumb facing up
Gently tap the reflex hammer on the tendon
Good result will be flexion and/or supination of the arm or seeing the flicker off the tendon

Question 8

Reflex testing: triceps

Answer 8

Nerve root of C7
Triceps tendon on the posterior part of the arm, above the elbow
Place your thumb or fingers over the tendon
Tap over it with the reflex hammer
Good result is the elbow extending or seeing the flicker of the tendon

Question 9

Reflex testing: clonus

Answer 9

Passive movements of the elbow/ankle
Then quicker speed extend/ dorsiflexion the joint
Positive result - spasms or high muscle tone

Question 10

Reflex testing: babinski

Answer 10

With sharp, pointed object (other end of reflex hammer or a pen)
Trace from the bottom of the sole of the foot up laterally to the little toe then across to the big toe
Normal response - nothing or toes will flex/ bend inwards
Positive result - big toe extension or slaying of all the toes

Question 11

Reflex testing: hoffmans

Answer 11

Patients hand is relaxed with some flexion at the wrist and partial flexion of the fingers
Hold the patients middle finger between your index and middle finger on the interphalangeal joint
Sharp and forceful flick of your thumb or finger on their middle finger
Normal result - finger will flex immediately followed by relaxation
Positive result - flexion and adduction of the thumb and flexion of the index finger

Question 12

PPIVM

Answer 12

Passive physiological intervertebral movements

Question 13

PPIVM: flexion

Answer 13

Supine
Both hands under the patients head and take the weight
Use one hand to find C2
Place your fingers into the spaces between the vertebrae
Flex the patients neck to feel the spaces open up

Question 14

PPIVM: rotation

Answer 14

Supine
Both hands under the patients head and take the weight
Use one hand to find C2
Place your fingers into the spaces between the vertebrae
Rotate the patients neck to the right and/or left to feel the cervical vertebrae rotate

Question 15

PPIVM: side flexion

Answer 15

Supine
Both hands under the patients head and take the weight
Use one hand to find C2
Place one finger to the side of the vertebrae in the Zygapophyseal joint
Side flex the patients neck to the right and/or left to feel the spaces of the joint close on the side you’re flexing

Question 16

PPIVM: rotation of C1

Answer 16

Sitting
Find C2 and then block its movements with the webbed space of your hands or pinch it
With your other hand place it on top of the patient head
Rotate their head
This allows only C1 to rotate in C2

Question 17

PPAVM

Answer 17

Passive accessory intervertebral movement

Question 18

PPAVM: PA on spinous process

Answer 18

Find T6 by using C7 and then count down
With your thumbs or pisiform of the hand place them on the spinous process of the identified vertebrae
Lean away from the head and push down/ up towards the head until resistance, stiffness or pain
Reduce the range of movement
Push with straight arms and use your body

Question 19

PPAVM: unilateral on transverse process

Answer 19

Find spinous process then move laterally and up (slightly) around the width of two thumbs to find the transverse process
With your thumbs push down until resistance, stiffness or pain
Reduce range of movement
Push with straight arms and use your body

Question 20

PPAVM: transverse glide on spinous process

Answer 20

Find spinous process of vertebrae and drop your thumbs to the side of the spinous process
Patient needs to be relaxed so the muscle isn’t in the way
Push the spinous process in a horizontal line
Push with straight arms and use your body