1. Evaluation of the Cervical SpineBy
B.Nelson

2. Outline of presentation
Review of anatomy of CS
Steps in evaluation of CS
Common conditions affecting the CS

3. Review of anatomy
Structure of Cervical Spine

4. History
The history often gives the therapist clues as to the source of the patient’s symptoms, nature and location of the involved structure ,the severity of the condition , and the activities or positions that aggravate or improve the patient’s condition

5. Examination /observation
Observation of the general posture as well as the relationship to the neck on the trunk and the head on the neck is observed when the patient is sitting, standing in the waiting room and the examination room
Clothing should be removed to expose the area

6. Observation cont’d Anterior- chin in line with sternum
Levels of the shoulder ( dominant side slightly lower than non- dominant side)
Lateral- ears in line with shoulder, lordotic curve
Note the presence of Torticollis
“poking chin”

7. Observation cont’d
Posterior- relationship between the CS and the rest of the spine
Muscle spasm or asymmetry

8. Movements- Active Upper cervical spine – Flex - nod
Ext – lift the chin without moving the neck
Lower cervical spine- flex ,ext, S. Flex, rot
NB; look for difference in range and ease to move
Most painful movement done last

9. Passive Movements & end feel
Done in supine
Greater ROM due to muscles being more relaxed
Normal end feel for all cervical movements is tissue stretch

10. Resisted movements Place the CS in a neutral position
Stabilise the trunk
Movts- flex, ext ,S.Flex & Rotation
the command for resisted movts is “Don’t let me move you”

11. Scanning of peripheral joints
To rule out pathologies in the peripheral joints
Temporomandibular jts
Shoulder joints
Elbow joints
Wrist and hand joints
Screen the glenohumeral ,acriomioclavicular, sternoclavicular and scapulothoracic joints

12. Muscle Power & myotome Neck flexion (C1- C2 myotome)
Neck side flexion (C3 myotome)
Shoulder elevation (C4 myotome)
Shoulder abduction (C5 myotome)
Elbow flexion (C6)
Elbow or wrist extension (C7)
Thumb extension (C8)
Finger abduction (T1)

13. Muscles of the CS

14. Muscles of the CS

15. Muscles of the CS

16. Special tests
Vertebral artery test – the vertebral artery is vulnerable to injury as it passes from the CS transverse processes to the cranium
Several tests – Vertebral artery test
Vertebrobasalar insufficiency leads to ischemic symptoms from the pons medulla and creebellum Dizziness, malaise and nausea, vomiting visual disturbance

17. Palpation
Position of patient – Supine , prone , or sitting with the head resting on the forearm which is at shoulder level
Palpate the posterior structures of the neck, lateral and anterior
Supine muscles are fully relaxed

18. Posterior aspect Spinous processes of C2 – C7 Mastoid process
Lateral aspect- transverse processes
TM jt , mandible parotid glands
Anterior aspect- first 3 ribs
Palpate the manubrium moving the fingers along laterally is the path of the firsr 3 ribs

19. Investigation
Imaging
X-rays
MRI

20. Common conditions of the CS
Cervical spondylosis
Spinal stenosis
Cervical rib/Thoracic Outlet Syndrome
Cervical Nerve Root impingement
Brachial Plexus

21. Suggested text Orthopaedic Physical Assessment by David Magee
Orthopaedic Medicine by Monica Kesson and Elaine Atkins
Living Surface Anatomy by Philip Harris and Craig Ranson