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Examination of the Cervical Spine

Look

  • Looking for Asymmetry:
    • # malunion, nonunion
    • Scoliosis
    • Muscular – Torticollis
    • Tumours, Glands

ANTERIOR

  • Landmarks – Hyoid C3, Thyroid C4/5, Cricoid C6
  • Sternum – Excavatum, Carinatum
  • Muscles – SM: Torticollis + facial asymmetry
  • Syndromes – Marfans, Turners
  • Axilla for freckles
  • Dysmorphic facies
  • Comment on height – Marfan’s
  • skeletal dysplasia (Down’s, achondroplasia, etc.)

LATERAL

  • Cervical Lordosis
  • Thoracic Kyphosis (Normal 21-33)
    • in Scheuermann’s, Ank Spon, #
  • Gibbus

POSTERIOR

  • Skin lesions (hairy naevus, café au lait, neurofibromas)
  • Wasting
  • Hair line – Klippel-Feil
  • Neck webbing
  • Shoulder height – Sprengels
  • List

GAIT

  • Ataxic – e.g. Arnold Chiari or post. column
  • Broad based, halting
  • Spastic
  • Heel walk, toe walk
  • Heel-toe walk for myelopathy/Cb disease
  • Rhombergs - post. column
    • -ve with eyes open, +ve with eyes shut
  • cerebellar
    • +ve with eyes open & closed

Feel

  • From Posterior
    • Deformity, Muscle Spasm, Tenderness
  • Spinous processes (C2 is first palpable)
  • Paravertebral muscles

Move

Sitting on examination couch

  • Mid-range pain suggests instability of moving segment (Degen.)
  • Flexion – chin to chest, measure distance off chest if ¯
  • Extension
    • face parallel to ceiling
    • (60% of F/E occurs at Occ/C1)
  • Lateral Rotation –
    • Normal=60-90, 50% occurs at C1/2
  • Lateral Bending – touch ear to shoulder

NEUROLOGICAL EXAMINATION

TONE, CLONUS

    • elbow flex/ext + pronation/supination
    • clasp-knife

POWER (MOTOR)

  • Shoulder Abduction (C5)
  • Elbow – Flexion (C6), Extension above head (C7)
  • Pronation – C7/8
  • Supination – C6
  • Wrist – Extension (C6), Flexion (C7)
  • Fingers - Extension (C7,C8), Flexion (C7,C8)
  • Abduction/adduction (T1)
    • Nerve Roots
    • C5 Deltoid. Comes out b/w C4/5
    • C5/6 Biceps
    • C6 Wrist Extensors.Most commonly affected by disc
    • C7 Triceps
          • Wrist flexors
          • Finger extensors
    • C8 Long finger flexors. Exits b/w C7/T1 foramen
    • T1 Interossei i.e. finger abduction/adduction incl. 1st dorsal

REFLEXES

  • Biceps – C5, C6
  • Triceps – C7
  • Brachioradialis – C5,C6
  • inverted supinator jerk

SENSATION

SPECIAL TESTS

MYELOPATHY

  • Rapid grip/release – 20 times in 10 seconds
  • Finger escape test
  • Hoffman’s sign – flick terminal phalanx of IF/MF » thumb IP jt flexes
  • Do LL’s if myelopathy
  • Scapulohumeral reflex for C1-C3 compression – tap acromion; +ve if
    • arm abduction / scapular elevation
  • Jaw jerk – increased in motorneurone disease but not myelopathy

RADICULOPATHY

  • Spurling’s test:
    • extension + lateral flexion to side of nerve root
    • compression and pain
  • Shoulder abduction relief test:
    • decreases radicular pain

KLIPPEL-FEIL

  • Hands: polydactyly, syndactyly, thumb hypoplasia, synkinesis
  • Scoliosis
  • Hair line
  • Shoulder height
  • C-spine ROM decreased

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