BY: KHUSHALI JOGANI
The Sarvajanik College Of Physiotherapy
Examination of movement
Cervical spine consists of 37 joints.
It has been said that cervical spine moves 600 times
per hour with normal activity.
An area where stability is sacrificed for mobility.
Divided into two areas: 1)cervicoencephalic
Lordotic curve in cervical region develops at 3 to 4
months of age as child lifts head.
At C4 to C5 interspace there is midpoint of curve.
Line of gravity falls anterior to foramen magnum
Abnormality from normal lordotic curve leads to
Reduction in cervical lordosis
Increase in cervical lordosis
Resting position: slight extension
Closed packed position: full extension
Capsular pattern: side flexion and rotation equally
Age and gender
Dominant side and affected side
Mechanism of injury
Onset of problem
Location of Pain or other symptom when it
Activities causing pain
Duration and frequency of symptoms
Has this occurred before and if so with what it
Are the intensity,duration frequency increasing?
Is pain periodic, episodic,occasional?
Is pain associated with rest,activity,postures?
Did the head strike to anything?
Radiation of pain?
Is pain affected by laughing, coughing, sneezing?
Does the patient have headache,where, frequency
and does any position changes it?
Is paraesthesia present?
Tingling or numbness (unilateral or bilateral)?
Any lower limb symptoms or difficulty in walking
Quality of pain and site and boundaries of pain?
Is the condition improving?Worsening? Staying
Activities aggravating or easing?
Restriction of movement?
Is there any difficulty in swallowing or voice
Sleeping position and type of pillow?
Any functional losses?
-Mc Gill –Melzack pain questionnaire
-Thermometer pain rating scale
Attitude of limb
Posture( standing and sitting)
Muscle spasm or any asymmetry?
Any muscle spasm or swelling?
Texture of skin and bony and soft tissues
Range of motion tests
Active movements to be checked
-flexion, extension, rotation(right &left), side
flexion(right & left)
Overpressure applied to check end feel
Normal end feel is tissue stretch(all motions)
Tools used are
Peripheral joint scan
Active range & overpressure
-wrist & hand
Myotomes (if weakness is due to neurological
-neck flexion: C1-C2
-neck side flexion:C3
-shoulder elevation: C4
-shoulder abduction/shoulder lateral rotation: C5
-elbow flexion and/or wrist extension:C6
-elbow extension and/or wrist flexion:C7
-thumb extension and/or ulnar deviation:C8
-abduction and/or adduction of hand intrinsic:T1
Using light touch and pin prick on the
dermatomal levels on both ride and left side.
-hoffmann’s sign( if UMN suspected)
-activities of daily living
-functional strength testing
If tightness is suspected muscle length test
should be done.
Checking for locking maneuver and quadrant
position for shoulder .
Common test done in cervical spine are:
-foraminal compression test(spurling’s test)
-upper limb tension test
-shoulder abduction test
-vertebral artery (cervical quadrant) test
Craniocervical flexion test
Thoracic inlet syndrome test
-3 min elevated arm exercise
Plain film radiography
-open or odontoid view