physiotherapy assessment

1. CERVICAL SPINE
ASSESSMENT
Dr. Anvita Telang (PT)
Assistant Professor (Musculoskeletal sciences)

5. Muscles of the cervical spine
POSTERIOR MUSCLES LATERAL MUSCLES ANTERIOR MUSCLES
Trapezius Anterior Scalene Longus capitis
Levator scapulae Middle Scalene Longus colli
Splenius capitus Posterior Scalene Rectus Capitis anterior
Splenius cervices Sternocleidomastoid Rectus Capitis lateralis
Semispinalis capitus
Semispinalis cervices
Longissimus capitus, cervices
Suboccipital muscles

6. Signs and Symptoms
• Pain – in the neck region, referred to shoulders or arms
• Stiffness
• Deformity
• Numbness
• Tingling
• Weakness
• Headaches

7. • Anaesthesia/dysthesia
• Ataxia
• Gait disturbances
• Nausea
• Poor balance
• Stiff neck
• Vertigo
• Visual disturbances

8. RED FLAGS
• Indicators of possible serious pathology such as inflammatory or
neurological conditions, structural musculoskeletal damage or
disorders, circulatory problems, suspected infections, tumours or
systemic disease. If suspected, these require urgent further
investigation and often surgical referral.

9. Signs and symptoms
• Pain worst at night
• Unexplained weight loss
• History of neoplasm
• Constant pain
• Fever, chills, night sweat
• Progressive neurological deficit
• Bowel bladder abnormalities
• Sensory disturbances

10. • Muscle wasting
• Weakness in the arms
• Balance abnormalities

11. Fracture
Neoplasm
Infection
Neurological injury
Cervical myelopathy
Vertebral artery insufficiency
Inflammatory or systemic diseases

13. Vertebrobasilar artery insufficiency
• Vertebrobasilar insufficiency (VBI) is
defined by inadequate blood flow
through the posterior circulation of
the brain, supplied by the 2 vertebral
arteries that merge to form the basilar
artery. The vertebrobasilar arteries
supply the cerebellum, medulla,
midbrain, and occipital cortex. When
the blood supply to these areas is
compromised, it can lead to severe
disability and/or death

14. Cervical myelopathy
• Myelopathy is an injury to the spinal cord due to severe
compression that may result from trauma, congenital stenosis,
degenerative disease or disc herniation.

15. Signs and symptoms
• Sensory disturbance of the hands
• Hand intrinsic muscle wasting
• Unsteady gait
• Babinski
• Clonus
• Hyperreflexia
• Bowel and bladder disturbances
• Multisegmental weakness
• Multisegmental sensory changes

16. Yellow flags
• Catastrophizing
• Finding painful experiences unbearable, reporting extreme pain disproportionate
to the condition
• Having unhelpful beliefs about pain and work – for instance, ‘if I go back to work
my pain will get worse’
• Becoming preoccupied with health, over-anxious, distressed and low in mood
• Fear of movement and of re-injury
• Uncertainty about what the future holds
• Changes in behaviour or recurring behaviours

17. PATIENT HISTORY
• Age
• Symptoms – neck, shoulder region, above or below elbow
• History of injury or trauma
• Mechanism of the injury
• Sites and areas of pain
• Radiation of the pain

18. • Pain increased by laughing, coughing, sneezing
• History of headaches
• Paraesthesia, tingling
• Numbness
• Weakness
• Lower limb symptoms

19. • Dizziness, fainting , epilepsy, seizure history
• Aggravating relieving factors
• Status of the pain – increasing, same or reduced
• Nature of the pain- continuous or intermittent

20. OBSERVATION

22. RANGES
FLEXION 45-50 Tissue stretch
EXTENSION 85 Tissue stretch
LATERAL FLEXION 40 Tissue stretch
AXIAL ROTATION 90 Tissue stretch

23. • Resisted isometric movements
• Peripheral joint scan- TMJ, shoulder girdle, Wrist hand, elbow
• Myotomes
• Dermatomes
• Reflexes
• Palpation
• Investigations

26. Functional Scales
• Neck disability index
• Oswestry disability questionnaire
• VAS
• NPRS

27. Special tests
• Distraction test
• Spurling's test
• ULTTS
• Hallpike-dix test
• Thoracic outlet tests

28. Differential diagnosis
• Cervical spondylosis
• Cervical radiculopathy
• Mechanical neck pain
• Whiplash injury/ fractures
• Cervical myelopathy
• TOS
• Brachial plexopathy