History & Examination of the Cervical Spine
History
- pain: where (neck v arm),rad,type,when,nocte,agg,rel,how long,headache
- other: stiffness,deformity,numb,weak, face, eyes
- function: coat,wash back,bra,toilet,comb,feed,high shelf, lift weight,throw,pull,work,sport,recr
- past hist: treatment,injury,surgery,similar episodes
Exam Shoulder
Exam
- look: swelling,wasting,deformity,scars, scapula anomalies
- feel: tenderness, lumps, muscle spasm, anterior structures
- move: flex,ext,lateral flex,rotate
- spec: Valsalva, foraminal compression, myelopathy, Adson's test
- power,neuro,vascular
Special Tests
- Radiculopathy maneuvres
- Valsalva ( or cough or straining)
- ↑ intrathecal pressure (+ve in disc pathology or tumours)
- Davidsons test
- abduct shoulder,flex elbow & put hand to head
- radicular pain will improve
- pain due to shoulder/ arm pathology will be worse or unchanged
- Foraminal compression test
- extension & lateral tilt to affected side will make pain worse
- Myelopathy manouvres
- Hoffman reflex
- +ve when the ipsilat IP joints of the thumb & index finger flex when the volar surface of the middle finger is flicked
- Extension of the neck ↑ the sensitivity of this test
- Inverted radial reflex
- spontaneous flexion of the digits when the examiner attempts to elicit the brachioradialis reflex
- L'hermitte sign
- flexion or extension of the neck causes paraesthesias or shock sensations
- usually in the legs, more often in flexion
- Babinski sign
- usually do not occur until myelopathy is severe
- Thoracic outlet manouvres
- thoracic outlet stress test
- ER/abduction/ extension of shoulder produces numbness of fingers
- Adsons test
- reproduction of symptoms, loss of radial pulse or appearance of a subclavian bruit with the arm held at 90° abduction & in ER
Webpage Last Modified:
18 February, 2010