Assessment of cervical spine


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assessment of cervical spine
Khushali Jogani
The Sarvajanik College Physiotherapy,

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Assessment of cervical spine

  1. 1. BY: KHUSHALI JOGANI The Sarvajanik College Of Physiotherapy Rampura,Surat ASSESSMENT OF CERVICAL SPINE
  2. 2. Contents:  Introduction  Patient history  Observation  Palpation  Examination of movement  Special tests  Diagnostic imaging  References
  3. 3. INTRODUCTION  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 2)cervicobrachial  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.
  4. 4.  Line of gravity falls anterior to foramen magnum  Abnormality from normal lordotic curve leads to following:  Reduction in cervical lordosis  Increase in cervical lordosis
  5. 5. Resting position: slight extension Closed packed position: full extension Capsular pattern: side flexion and rotation equally limited,extension
  6. 6. PATIENT HISTORY  Age and gender  Occupation  Address  Dominant side and affected side  Chief complaint  Mechanism of injury  Onset of problem
  7. 7.  Location of Pain or other symptom when it started  Activities causing pain  Duration and frequency of symptoms  Has this occurred before and if so with what it relieved ?  Are the intensity,duration frequency increasing?  Is pain periodic, episodic,occasional?  Is pain associated with rest,activity,postures?
  8. 8.  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 or balance?
  9. 9.  Quality of pain and site and boundaries of pain?  Is the condition improving?Worsening? Staying the same?  Activities aggravating or easing?  Restriction of movement?  Is there any difficulty in swallowing or voice changes?  Sleeping position and type of pillow?  Any functional losses?  Dizziness?
  10. 10.  Medical history  Drug history  Surgical history  Economic history  Social history  Pain history -VA Scale -Mc Gill –Melzack pain questionnaire -Thermometer pain rating scale
  11. 11. OBSERVATION  Body built  Assistive device  Attitude of limb  Posture( standing and sitting) lateral anterior posterior
  12. 12.  Muscle spasm or any asymmetry?  Facial expression?  AnyTrophic changes?
  13. 13. PALPATION  Tenderness  Trigger points  Any muscle spasm or swelling?  Texture of skin and bony and soft tissues -posterior -anterior -lateral
  14. 14. EXAMINATION  Range of motion tests  Active movements to be checked -flexion, extension, rotation(right &left), side flexion(right & left) -combined movement -repetitive movement -sustained position  Overpressure applied to check end feel  Normal end feel is tissue stretch(all motions)
  15. 15. Tools used are -Goniometer -CROM -Inclinometer
  16. 16.  Functional OA ROM  Functional AA ROM
  17. 17.  Resisted isometric movements
  18. 18.  Peripheral joint scan Active range & overpressure -TM joint -scapula -Shoulder joint -elbow joint -wrist & hand  MMT -cervical muscles
  19. 19. -scapular muscles  Myotomes (if weakness is due to neurological involvement) -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
  20. 20.  Sensory examination Using light touch and pin prick on the dermatomal levels on both ride and left side.  Reflex evaluation -biceps jerk(C5-C6) -triceps jerk(C7) -brachioradialis jerk(C6) -jaw jerk -hoffmann’s sign( if UMN suspected)
  21. 21.  Functional assessment -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 .
  22. 22. SPECIAL TESTS  Common test done in cervical spine are: -foraminal compression test(spurling’s test) -distraction test -upper limb tension test -shoulder abduction test -vertebral artery (cervical quadrant) test
  23. 23.  Craniocervical flexion test  Thoracic inlet syndrome test -adson’s test -costoclavicular -hyperabduction -3 min elevated arm exercise
  24. 24. DIAGNOSTIC IMAGING  Plain film radiography -lateral view -open or odontoid view -oblique view  CT Scan  MRI
  25. 25. REFERENCES  Orthopaedic physical therapy -DONNATELLIWOODEN (third edition)  Orthopaedic physical assessment -DAVID J.MAGEE(fifth edition)  Orthopaedic examination, evaluation,& intervention -MARK DUTTON
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