Examination of the Cervical Spine

Examination of the Cervical Spine, lateral radiograph of a normal cervical spine
Lateral radiograph of a normal cervical spine. Image by Staff at the Department of Radiology, UC San Diego Health., Wikimedia Commons, Public domain.

Summary

  • Look at posture, alignment and gait
  • Feel bony landmarks and paraspinal muscles
  • Move through flexion, extension, lateral flexion and rotation
  • Upper limb tone, power, reflexes and sensation
  • Upper motor neurone signs including Hoffmann sign and clonus
  • Special tests including Spurling test and shoulder abduction relief
  • Lower limb neurology and gait for myelopathy

Look

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

Anterior

  • Landmarks
    • Hyoid C3, Thyroid C4/5, Cricoid C6
  • Sternum
    • Excavatum, Carinatum
  • Muscles
    • Sternocleidomastoid
      • Torticollis + facial asymmetry
  • Syndromes – Marfans, Turners
  • Axilla for freckles
  • Dysmorphic facies
  • Comment on height

Lateral

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 posterior column
  • Broad based, halting
  • Spastic
  • Heel walk, toe walk
  • Heel-toe walk for myelopathy/Cb disease
  • Rhombergs – posterior 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
  • 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 flexion / extension + 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 between C4/5
  • C5/6 Biceps
  • C6 Wrist Extensor
    • Most commonly affected by disc
  • C7 Triceps
    • Wrist flexors
    • Finger extensors
  • C8 Long finger flexors
    • Exits between C7/T1 foramen
  • T1 Interossei
    • i.e. finger abduction/adduction including 1st dorsal

Reflexes

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

Sensation

  • C5 lateral arm over the deltoid
  • C6 thumb and lateral forearm
  • C7 middle finger
  • C8 little finger and ulnar border of hand
  • T1 medial elbow and upper forearm
  • Test light touch and pinprick, comparing sides
  • Glove distribution loss suggests myelopathy or peripheral neuropathy

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 joint flexes
  • Do LL’s if myelopathy
  • Scapulohumeral reflex for C1-C3 compression
    • tap acromion
      • +ve if
        • arm abduction / scapular elevation
  • Jaw jerk – ↑ in motorneurone disease but not myelopathy

Radiculopathy

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

Klippel-Feil

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

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.