2. Presented by MD.NIJAM UDDIN SHAIKH

4. THE CERVICAL SPINE
ANATOMY

6. THE CERVICAL SPINE ANATOMY:
The spinal column is a series of
motion segments each of which
consist of an inter- body joint and
it's two adjacent zygapophyseal
joints formed between the
posterior arches of the vertebra
above and below.

7. The cervical spine is designed for
mobility.
The cervical spine is most mobile
spine .
It's wide range of verity of
movement are relegated to
change in the direction of vision
the positioning of the upper limbs
and hands and loco motion.

8.  It is also an area of potential
danger as it gives bony
protection two major blood
vessel that supply the brain
and spinal cord.

9. ANATOMICAL AND
FUNCTIONAL SEGMENT
OF CERVICAL SPINE

11. Anatomically and functionally the cervical
spine can be divided into two segments.
The upper segments :consists of the atlas and
axis(c1_2).
Function:
It’s structure is designed for mobility with
approximately one-third of cervical flexion and
extension and over half of axial rotation
occurring at this level

13. segments.
The upper segments:
consists of the atlas and axis(c1_2).
Function:
it’s structure is designed for
mobility with approximately one-
third of cervical flexion and
extension and over half of axial
rotation occurring at this level

14. The lower segment:
consist of the remaining cervical
vertebra (c3_7) function
contribute to overall mobility.

16. Formation of cervical spine :
Cervical spine is formed by 7th
vertebra and 8th pairs nerves.

17. Special test for
cervical spine

18. Five special test are directly
releated to the cervical spine.
Distraction test.
The compression test.
The valsalva test.
Swallowing test.
Adson test.

19. Distraction Test

20. This test demonstrated the effect
that neck traction might have in
relieving pain.
Distraction relieves pain due to a
narrowing ofof the neural
foramen(and the result of the
nerve root compression) by
widening the foramen.

21. Distraction also relieves pain in
the cervical spine by
decreasing pressure on the
joint capsule around the fascet
joint.

22. In addition;it may help to
alleviate muscle spasm by
relaxing the contracted
muscles.

23. To perform the cervical spine
distraction test place the open
palm of one hand under the
patient chin
The other hand upon his occiput.
Then gradually lift the (distract)
head to remove it’s weight from
the neck.

25. Compression Test

26. A narrowing of the neural
foramen,pressure on the fascet
joints,or muscle spasm can cause
increased pain upon compression.in
addition the compression test may
faithfully reproduce pain referred to
the upper extremity from the
cervical spine.

27. Indoing so,may help locate
the neurologic level of any
existing pathology.

28. To perform the compression test
press down upon the top the
patients head while he is either
sitting or lying down. if there is
increase in pain either cervical
spine or the extremity note its
distribution and whether if
follows any previously described
the dermatome

30. Valsalva Test

31. This test increase intra-thecal
pressure.If a space occupying
lesion.such as a herniated disc
or a tumor.is present in the
cervical canal.the patient may
develop pain in the cevical spine
secondary to increased
pressure.

32. The pain may also radiate to
the dermatome distribution
that corresponds to the
neurological logical level of the
cervical spine pathology.

34. To perform the valsalva test have
the patient hold his breath and
bear down as if he were moving his
bowels.then ask whether he feels
any increase in pain and if so
whether he can describe the
location.note that the valsalva test
is a subjective test which requires
accurate response from the
patient.

35. Swallowing Test

36. Difficulty or pain upon swallwoing
can sometime be caused by
cervical spine pathology such as
bony protuberances.Bony
osteophytes or by soft tissue
swelling due to
haematoma,infection,or tumor in
the anterior portion of the cervical
spine.

38. Adson Test

39. This test is used to determine the
state of the sub clavian artery
which may be compressed by an
extra cervical rib or by tightened
scalenus anticus and scalenus
medius muscle,which can
compress the artey where it
passes between them on its away
to the upper extremity.

40. How to perform Adson test?

41. To perform the adson test
check the patient radial pulse
at the wrist. As you continue to
feel the pulse abduct,extend
and externally rotate his
arm.Then instruct him to take a
deep breathing.

42. To turn his head towards the
arm being tested,if there is
compression of the subcalavian
artery,physiotherapist will feel
a marked absence of the radial
pulse.