Intro to Cervical Examination Flashcards
Week 1 (33 cards)
Why is the cervical spine an area of high concern for injury?
Due to its proximity to the spinal cord and risk of serious complications
When it comes to the cervical spine. patients should be examined for:
central/peripheral neurologic deficit
neurovascular compromise
serious skeletal injuries (fxs or craniovertebral ligamentous instability)
What are the four classification categories for neck pain?
1) Neck pain with mobility deficits
2) Neck pain with movement coordination impairments
3) Neck pain with headaches (cervicogenic)
4) Neck pain with radiating pain (radicular)
What are a few exam findings for neck pain w/ mobility deficits?
limited cerv ROM
pain reproduced at end range of AROM/PROM
restricted segmental mobility
What are a few exam findings for neck pain w/ movement coordination impairments (whiplash)?
(+) cranial cerv flexion test
(+) neck flexor endurance test
strength/edurance deficits of neck muscles
pain that worsens with end range positions
What are a few exam findings for neck pain w/ headaches?
(+) cerv flex. rotation test
headache reproduced w/ provocation
limited cerv. ROM
strength/endurance/coordination deficits
What are a few exam findings for neck pain w/ radiating pain?
neck/neck-related radiating pain reproduced/relieved w/ radiculopathy testing
(+) cluster test of ULNT, spurling’s, distraction
What structures are assessed first after ruling out vertebral artery and transverse ligament damage?
Bone, muscles, ligaments, zygapophyseal joints, intervertebral discs (IVD). A quick TMJ examination should also be performed.
What are the most common symptoms of cervical disorders?
Ongoing or motion-induced neck/arm pain and suboccipital headache.
When should more severe damage be suspected?
if there are neurologic symptoms after the trauma (paresthesias, dizziness, tinnitus, Lhermitte’s sign)
What in the patient history would lead you to suspect cervical instability?
cervical symptoms that are exacerbated in a vertical position but relieved with the head supported in supine (esp. w/ N/T in face)
What is Lhermitte’s sign, and what does it indicate?
Electric shock-like symptoms down the spine with neck flexion; suggests inflammation or irritation of the meninges.
Symptoms associated with coughing and sneezing are often
associated with…
disk pathology
What are red flags in a cervical systems review?
Unexplained weight loss, progressive pain, neurological deficits, visual disturbances, severe movement loss, and recent trauma.
What are early indicators of cervical myelopathy?
Symptoms in multiple extremities, difficulty with fine motor tasks, clumsiness (balance/walking difficulties too), hyperreflexia, and spasticity.
What are the key differences between cervical myelopathy and cervical radiculopathy?
Myelopathy (Spinal Cord Compression)
- Bilateral weakness, spasticity, hyperreflexia, gait issues
- UMN signs (Hoffman’s, Babinski)
- No dermatomal pattern
Radiculopathy (Nerve Root Compression)
- Unilateral pain, numbness, weakness
- Dermatomal pattern, hyporeflexia
- LMN signs
Which segment is myelopathy most likely to occur in the cervical spine?
C5-C6 due to the region of the spinal cord being at its widest and the canal at its narrowest
What are the Canadian C-Spine Rules for imaging?
C-Spine imaging is needed if:
- High-risk factors (Age ≥65, dangerous mechanism, paresthesias)
- Cannot safely assess ROM (Midline tenderness, cannot sit up/walk, delayed onset pain, high-energy accident)
- Cannot rotate neck 45° left & right
If all low-risk criteria are met & Pt can rotate 45° bilaterally, no imaging needed.
When should a Pt with neck pain be referred?
Recent trauma (last 6 weeks)
Severe movement loss, spasm, or paresthesia
UMN signs (hyperreflexia, balance issues)
Bilateral UE symptoms or progressive neuro deficits
Constant, severe pain or headaches
Memory loss, confusion, or mood changes
sympathetic symptoms deserve special attention - blurred vision, sweating, tinnitus
What symptoms suggest vertebral artery insufficiency?
Dizziness, drop attacks, hemifacial numbness, dysphagia, and visual disturbances.
What myotomes correspond to C2-T1 in upper quarter screening?
C2-C4: Shoulder Shrug
C5: Shoulder Abduction
C6: Elbow Flexion/Wrist Extension
C7: Elbow Extension/Wrist Flexion
C8: Thumb Extension/Finger Flexion
T1: Finger Abduction.
What dermatomes correspond to C4-T2 in upper quarter screening?
C4 - Acromion
C5 - Lateral humerus
C6 - Thumb/Index finger
C7 - 3rd Digit
C8 - lateral 5th digit
T1 - medial forearm
T2 - medial humerus
What reflexes correspond to C5-C8 in upper quarter screening?
C5-6: biceps
C5-6: Brachioradialis
C7-8: triceps
What are the grades of reflexes?
0 = no reflex
1+ = minimal reflex
2+ = Normal
3+ = brisk response
4+ = hyperresponsive
