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Examination of cervical disorder


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Examination of cervical disorder

  1. 1. EXAMINATION OF CERVICAL DISORDER Presented by Kaushal sinha 1st year PG Dept. of panchakarma SDM college of ayurveda 4/24/2016 1
  2. 2. CONTENT:-  Introduction  Region of spine  Function of spine  Examination of cervical spine (A)General pysical examination (B)Special test (C)Range of movement  conclusion 4/24/2016 2
  3. 3. INTRODUCTION  33 vertebrae  31 pair nerve roots  23 disc  Spinal cord- Contained in epidural space Network of sensory and motor nerves Firm, cord-like structure Conus medullaris Filum terminale Cauda equina Foramen magnum Conus medularis Cauda equina 4/24/2016 3
  4. 4. SAGITTAL PLANE CURVES  Cervical Lordosis 20°- 40  Thoracic Kyphosis 20°- 40°  Lumbar Lordosis 30°- 50  Sacral Kyphosis 4/24/2016 4
  5. 5. REGION OF THE SPINE  Cervical  Upper cervical: C1-C2  Lower cervical: C3-C7  Thoracic: T1-T12  Lumber: L1- L5  Sacrococcygeal: 9 fused vertebrae in the sacrum and coccyx 4/24/2016 5
  6. 6. FUNCTIONS OF SPINE:-  Posture  Spinal cord encasement  Weight transmission  Posture  Vital organs back support  Muscles attachment 4/24/2016 6
  7. 7. WHAT IS CERVICAL SPINE Consist of 7 vertebra 8 nerves Give two plexuses:- Cervical plexus ( C1-C5) Phernic ( C3,C4,C5 Lesser occipital (C2) Supraclaviclular ( C3,C4) brachial plexus ( C5-T1) mucocutanous n (C5-C7) axillary n (C5-C6) median n (C5-T1) radial N (C5-T1) ulnar n (C8-T1) 4/24/2016 7
  8. 8. CERVICAL DISORDER  Cervical spondylosis  Cervical radiculopathy  Cervical myelopathy  Cervical Strain/spasm  Cervical Sprain  Cervical Stenosis  HNP(Herniated Nucleus pulposus)  Cervical Cord Neuropraxia  Fractures/subluxation etc. 4/24/2016 8
  10. 10.  Herniated disc- The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 - C5 level, and rarely the C7 - T1 level may herniate4 Cause- some sort trauma & injury  Bone spur- Cervical osteophytes are bone spurs that grow on any of the seven vertebrae in the cervical spine (neck), involving the spine from the base of the skull to the base of the neck (C1 - C7 vertebrae) Cause- inflamed or damaged tissue, cervical osteoarthritis, cervical spondylosis Other types of arthritis, traumatic injury, and poor posture  Narrow disc space- cervical foraminal stenosis (narrowing of the cervical disc space) may arise without any disc herniation. The majority of symptoms with this type of cervical stenosis are usually caused by one nerve root on one side 4/24/2016 10
  11. 11. EXAMINATION OF CERVICAL SPINE  History  General Examination  Inspection  Palpation  Special Test  Range of Movement 4/24/2016 11
  12. 12. EXAMINATION TECHNIQUE:-  Introduce yourself  Ask permission to perform examination  Explain the patient appropriately  The patient must be exposed properly  Tell the patient to let you know if anything you do uncomfortable and painful  When female patient make sure that female nurse & assistant is present. 4/24/2016 12
  13. 13. HISTORY  Male / Female  Occupation  Socio economic class  Presenting chief complaints  History of presenting ilness  Treatment history  Past history  Personal history  Family history 4/24/2016 13
  14. 14. ASK FOR…  H/o Trauma  H/o constitutional symptoms  H/o Hemoptysis  H/o Respirory symptoms,dysponea  H/o Other joint involements  H/o Pelvic inflammatory  Treatment histoy  Immunization history BCG,polio 4/24/2016 14
  15. 15. PAST HISTORY  Similar complains  Prolonged history  Previous surgery  DM  HTN  Tuberculosis  Hematological disorder  Any neurological disorder 4/24/2016 15
  16. 16. PERSONAL HISTORY  Smoking  Alcohol  Drug addiction  Diet  Bowel bladder habbit  Appetite  Menstrual history in female 4/24/2016 16
  17. 17. FAMILY HISTORY  Similar illness  Tuberclosis  HTN  DM 4/24/2016 17
  18. 18. INSPECTION (A) Standing Look from the side normal spine > cervical lordosis  Increased lordosis – muscular weakness or imbalance  Lessened lordotic curve - muscular spasm/guarding and/or nerve root impingement 4/24/2016 18
  19. 19. (B) Position of Head Relative to Shoulders  Head should be seated symmetrically on cervical spine  Lateral flexion - from unilateral spasm of muscles – strain and/or spasm (guarding)  Rotation – from unilateral spasm of sternomastoid muscle – strain and/or spasm (guarding) or torticollis 4/24/2016 19
  20. 20. PALPATION  Local rise in temperature  Palpate all spinous process  Prominent spinous process Feel → The midline spinous processes → The paraspinal soft tissues → The supraclavicular fossae – for cervical ribs or enlarged lymph nodes → The anterior neck structures including the thyroid 4/24/2016 20
  21. 21. SPECIAL TESTS  Cervical spine :  Spurling test  Compression test  Distraction test  Valsalva test  Swallowing test  Adson test  Range of motion:  Active  Passive 4/24/2016 21
  22. 22. SPECIAL TEST:- Movement (A) Flexion - ask the patient to bend the head forwards - chin should be able to touch the chest - normal : 80° (B) Extension - ask the patient to look up and back - normal : 50° 4/24/2016 22
  23. 23. RANGE OF MOTION TESTING Active:-  Best done in sitting or standing  Flexion – touch chin to chest  Extension – look straight above head  Lateral flexion – approximately 45 degrees  Rotation – nose over tip of shoulder Passive:-  Best done laying supine  Flexion – firm end feel  Extension – hard end feel (occiput on cervical spinous processes)  Lateral flexion – firm end feel (stabilize opposite shoulder)  Rotation – firm end feel 4/24/2016 23
  24. 24. (C) Lateral flexion - ask the patient to touch his shoulder with the ear - involve atlanto-axial and atlanto-occipital joints - normal : 45° (D) Rotation - ask the patient to look over his shoulder - normal : 80° - restricted and painful in cervical spondylitis 4/24/2016 24
  25. 25. COMPRESSION TEST  Testing for compression of cervical nerve root or facet joint irritation in the lower cervical spine  Ask the patient seat the table  Patient head is natural,therapist stands behind patient  Positive sign –  Radiating pain or other neurological sign in the same side arm(nerve root) and pain local to the neck or shoulder  A narrowing of neural foramen, pressure on the facet joints or muscle spasm can cause increase pain upon compression 4/24/2016 25
  26. 26. SPURLING TEST  Same positioning as cervical compression test  Compression of a cervical nerve root or facat joint irritation in the lower cervical spine  Patient slowly extends,sidebend,and rotates the head of affected side.  Therapist carefully compression downword on the head of patient  Positive sign:- Radiating pain or other neurological sign in the same side arm(nerve root) and pain local to the neck or shoulder (facet joint irretation) 4/24/2016 26
  27. 27. DISTRACTION TEST  To relive the pressure on the cervical roots (may be used after spurlling or compression test)  Place the open palm of one hand under the pt’s chin, and the other hand is upon occiput & tempolallis  Then, gradually lift (distract) the head to remove its weight from the neck  To demonstrate the effect that neck traction might have help in relieving the pain by decreasing pressure on the joint capsules around the facet joints. 4/24/2016 27
  28. 28. VALSALVA TEST  Ask pt to hold his breath and bear down as if he were moving his bowels  Then, ask whether he feels any increase in pain and describe the location  This test increase intratechal pressure  If a space occupying lesion, such as a herniated disc or a tumor present in cervical canal, pt may develop pain in cervical spine secondary to increase pressure  The pain also may radiate to the dermatome distribution of cervical spine pathology 4/24/2016 28
  29. 29. SWALLOWING TEST  Difficulty or pain upon swallowing can sometimes caused by cervical spine pathology such as :  Bony protuberance  Bony osteophytes  Soft tissue swelling due to hematomas, infection or tumor in ant portion of cervical spine 4/24/2016 29
  30. 30. LHERMITTE’S SIGN  This sign detects protrusion of cervical intervertebral disc or an extradural spinal tumour irritating the spinal duramater.  The patient sits on an examining table,now the head of the patient is bent down passively(flexion of cervical spine ) and simultaneously the lower limbs are lifted(flexing the hip joints) keeping the knees straight. This will causes sharp pain radiating down the spine and to both the extremities. 4/24/2016 30
  31. 31. ADSON TEST  Pull the arm downwards  Palpate the radial pulse  Turn the pt’s head to the same side and extend the neck  Abduct, extend, and laterally rotate the shoulder.  From this position, have the patient take a deep breath and hold  Feel the radial pulse  Fading of the radial pulse indicates positive thoracic outlet obstruction 4/24/2016 31
  32. 32. CONCLUSION:-  Facet joint spondylosis and herniation of the intervertebral disc are the most common causes of nerve root compression.  Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques will lead to rapid diagnosis and improved patient care.  This knowledge is important for all practitioners. Rapid diagnosis and treatment will lead, ultimately, to a greater chance for early recovery for the patient affected by this condition. 4/24/2016 32
  33. 33. Thank you...... 4/24/2016 33