Exam Cervical USA

7/27/2019 Exam Cervical USA

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Cervical Orthopedic Tests

Chapters 3 & 4


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Tenderness Grading Scale

Grade Imild tenderness to palpation

Grade IImild tenderness with grimace

and flinch to moderate palpation

Grade IIIsevere tenderness with

withdrawal

Grade IVsevere tenderness with

withdrawal from noxious stimuli


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Cervical Palpation (Anterior)

Sternocleidomastoid

Carotid arteries

Supraclavicular Fossa


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Cervical Palpation (Posterior)

Trapezius

Cervical intrinsic musculature

Spinous processes / facet joints


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Cervical Range of Motion

Take a thorough history to be certain thatthese motions will not adversely affect the

patient.Trauma causing fracture, dislocation, orvascular compromise would becontraindications to performing these tests.

Note limited range of motion.

Note pain location and character.


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Normal Cervical ROM

Flexion50 degrees or more

Extension60 degrees or more

Lateral flexion45 degrees or more

Rotation80 degrees or more


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Cervical Resistive Isometric

Testing

Evaluate muscle strength and state.

Weakness may indicate neurological

dysfunction.

Pain indicates muscle dysfunction such as a

strain.


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Muscle Grading Scale

5Complete range of motion against gravity withfull resistance.

4Complete range of motion against gravity withsome resistance.

3Complete range of motion against gravity.

2Complete range of motion with gravity

eliminated.1Evidence of slight contractility.

0no evidence of contractility.


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Vertebrobasilar Circulation

Assessment

Vascular Insufficiency may be aggravated

by positional change in the cervical spine.

Assessment of the vertebrobasilarcirculation must be done if cervical

adjustment or manipulation is to be

performed.


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Predispositions to

Cerebrovascular Accidents

Headaches, migraine

Dizziness

Sudden severe head or neck pain

Hypertensive


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Predispositions to

Cerebrovascular Accidents

Cigarette smoking

Oral Contraceptives

Obesity

Diabetes


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Cerebrobasilar Testing

Positional change in the cervical spine

compresses the vertebral artery at the

atlantoaxial junction on the side opposite ofrotation.

In the normal patient, the diminished blood

flow does not cause any neurologicalsymptoms, such as dizziness, nausea,

tinnitus, faintness, or nystagmus.


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Clinical Signs and Symptoms of

Cerebrovasular Episodes

Vertigo, dizziness, giddiness, light-

headedness

Drop attacks, loss of consciousness

Diplopia

Dysarthria


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Cerebrovasular Episodes

Dysphagia

Ataxia of gait

Nausea, vomiting

Numbness on one side of the face

Nystagmus


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Barre-Lieou Sign

Procedure: Patient rotates head from one

side to the other.

Positive Test: Vertigo, dizziness, visualblurring, nausea, faintness, nystagmus.

Structure affected: Vertebral artery on the

same side of head rotation. Considerpatency of the carotid arteries and the

communicating cerebral artery circle.


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Barre-Lieou Sign


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Vertebrobasilar Artery

Functional Maneuver

Procedure: Palpate and auscultate the

carotid arteries for pulsations and bruits.

Instruct the patient to rotate andhyperextend the head.


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Functional Maneuver

Positive Test: If pulsation or bruits are

present at either the carotid or subclavian

arteries the test is positive.Structures Affected: It may indicate

stenosis or compression of the carotid or

subclavian arteries.


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Functional Maneuver


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Maignes Test

Procedure: Patient extends and rotates the

head and holds that position for 1540

seconds. Repeat on opposite side.Positive Test: Vertigo, dizziness, visual

blurring, nausea, faintness, and nystagmus.

Structures Affected: Vertebral, basilar, orcarotid artery stenosis or compression.


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Maignes Test


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Dekleyns Test

Procedure: Patient supine, head off table.

Instruct pt. to hyperextend and rotate head.

Hold 15 to 30 seconds. Repeat opposite.Positive Test: Vertigo, dizziness, visual




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Dekleyns Test


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Hautants Test

Procedure: Pt. Seated, eyes closed, extend

arms to front with palms up. Pt. extend and

rotate head.Positive Test: Patient loses balance, drops

arms, and will pronate the hands.



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Hautants Test


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Underburgs Test

Procedure: Pt. standing. Close eyes and

assess equilibrium. Stretch arms and

supinate hands. Then pt. marches in place.Then pt. extends and rotates head while

marching. Then opposite side.


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Underburgs Test

Positive Test: Patient loses balance, arms

drift, hands pronate. Vertigo, dizziness,

visual blurring, nausea, faintness, andnystagmus.

Structures Affected: Vertebral, basilar, or

carotid artery stenosis or compression.


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Underburgs Test


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Hallpikes Maneuver

Procedure: Pt. supine with head extended

off table. Support head and move it into

extension. Then laterally flex and rotate.Hold 15 to 40 seconds. Repeat opposite.

Then hang head in free hyperextension.


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Hallpikes Maneuver

Positive Test: Vertigo, dizziness, visual




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Hallpikes Maneuver


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Hallpikes Maneuver

Cli i l Si d S t f


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Cervical Strain or Sprain

Cervical and upper back pain

Cervical and upper back stiffness

Cervical and upper trapezius tightness

Reduced cervical range of motion

Cervical extensor spasm

Diff ti ti B t St i


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Differentiating Between Strain

and Sprain

Cervical strainis an irritation and spasm of

the musclesof the cervical spine with or

without partial muscle fiber tearing.Cervical sprainis a wrenching of the joints

of the cervical spine with partial tearing of

its ligaments.


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Categories of Strain

Mild: Slight disruption of muscle fibers

with no appreciable hemorrhage and

minimal amounts of swelling and edema.


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Categories of Strain

Moderate: Laceration of muscle fibers with

an appreciable amount of hemorrhage into

the surrounding tissues and a moderateamount of swelling and edema.

Severe: Complete disruption of the muscle

tendon unit, possibly with tearing of thetendon from the bone or a rupture of the

muscle through its belly.


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Categories of Sprain

Mild: Slight tears of a few ligamentous

fibers.

Moderate: More sever tearing ofligamentous fibers but not complete

separation of the ligament.


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Categories of Sprain

Severe: Complete tearing of a ligament

from its attachments.

Avulsion: A ligament that attaches to abone is pulled loose with a fragment of that

bone.


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ODonoghues Maneuver

Procedure: Patient seated. Put the cervical

spine through resisted range of motion, then

through passive range of motion.Positive Test: Pain during resisted range of

motion or isometric muscle contraction

signifies muscle strain. Pain during passiverange of motion may indicate a sprain of

any of the cervical ligaments.


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ODonoghues Maneuver

Structures Affected: Cervical spinal

muscles and/or cervical spinal ligaments.

Since resisted range of motion mainlystresses muscles and passive range of

motion mainly stresses ligaments, you

should be able to determine between strainand sprain or a combination thereof.


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ODonoghues Maneuver


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Spinal Percussion Test

Procedure: Patient seated. Head slightly

flexed, percuss the spinous process and

associated musculature of each cervicalvertebrae with a reflex hammer.


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Positive Test: Local pain may be a

fractured vertebra with no neurological

compromise. Radicular pain may be afractured vertebra with neurological

compromise or a disc lesion with

neurological compromise. A ligamentous

sprain could also elicit pain upon percussion

of the spinous processes.


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Soto-Hall Test

Procedure: Patient Supine. Press on the

patients sternum with one hand. With the

other hand, passively flex the patients headto the chest.

Positive Test: Local pain could indicate

ligament, muscular, ossous pathology orcervical cord disease. Suspect disc defect

with radicular symptoms.


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Soto-Hall Test


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Rusts Sign

Procedure: A patient with severe injury to

the upper cervical spine will grasp the head

with both hands to support the weight of thehead on the cervical spine. The supine

patient will support the head while

attempting to rise.

Positive Sign: The patient stabilizes the

head. It might include slight traction.


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Rusts Sign

Structures Affected: This could represent

severe muscular strain, ligamentous

instability, posterior disc defect, uppercervical fracture, or dislocation.


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Rusts Sign

Cervical Instability Clinical


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Cervical Instability Clinical

Signs and Symptoms

Severe cervical pain.

Patient stabilizing the head.

Little or no cervical motion.

Severe cervical muscle spasm.

Upper extremity neurological dysfunction.

Lower extremity neurological dysfunction.


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Space-Occupying Lesions

Clinical Signs and Symptoms

Cervical pain.

Upper extremity neurological symptoms. Lower extremity neurological symptoms.


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Valsalvas Maneuver

Procedure: Have the patient bear down as if

defecating and focus the bulk of the stress

on the cervical spine. Ask if the patientfeels pain and have them point to the

location.


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Valsalvas Maneuver

Positive Test: Local pain with increased

pressure could indicate a space-occupying

lesion (e.g. disc defect, mass, osteophyte) inthe cervical canal or foramen.


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Valsalvas Maneuver


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Dejerines Sign

Procedure: Patient seated. Instruct them to

cough, sneeze, and bear down as if

defecating (Valsalvas maneuver).Positive Test: Local pain or pain radiating

to the shoulders or upper extremities

indicates an increase in intrathecal pressure.Structures Affected: Space-occupying

lesion.

Cervical Neurological


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Cervical Neurological

Compression and Irritation

Clinical Signs and Symptoms

Cervical pain.

Upper extremity radicular pain. Loss of upper extremity sensation.

Loss of upper extremity reflexes.

Loss of upper extremity muscle strength.


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Foraminal Compression Test

Procedure: Patient seated. Exert strong

downward pressure on the head. Repeat

with b/l rotation.Positive Test: Local pain may indicate

foraminal encroachment without nerve root

pressure or apophyseal capsulitis.Radicular pain may indicate pressure on a

nerve root.


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Foraminal Compression Test


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Jacksons Compression

Procedure: Laterally flex the head and exert

strong downward pressure. Perform b/l.

Positive Test: Local pain may indicateforaminal encroachment without nerve

pressure or apophyseal joint pathology.

Radicular pain may indicate pressure on anerve root.


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Jacksons Compression


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Spurlings Test

Procedure: Laterally flex the patients head

and gradually apply strong downward

pressure. If no pain is elicited, put thepatients head in a neutral position and

deliver a vertical blow to the uppermost

portion of the patients head.


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Spurlings Test

Positive Test: Local pain indicates facet

joint involvement. Radicular pain indicates

nerve root pressure.


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Spurlings Test

Maximum Foraminal


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Maximum Foraminal

Compression Test

Procedure: Have the patient approximate

the chin to the shoulder and extend the

head. Perform b/l.

Maximum Foraminal


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Maximum Foraminal

Compression Test

Positive Test: Pain on the side of rotation

with a radicular component may indicate

nerve compression. Local pain with noradiculopathy may indicate apophyseal joint

pathology on the side of rotation. Pain

opposite of rotation indicates muscular or

ligamentous strain.

Maximum Foraminal


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Maximum Foraminal

Compression Test


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Shoulder Depression Test

Procedure: Apply downward pressure on

the shoulder while laterally flexing the

patients head to the opposite side.


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Positive Test: Local pain on the side being

tested indicates shortening of the muscles,

muscular adhesions, muscle spasm, orligamentous injury. Radicular pain may

indicate compression of the neurovascular

bundle or thoracic outlet syndrome. Pain on

the opposite side indicates a decreased

foraminal space, facet pathology, or disc

defect.


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Distraction Test

Procedure: Grasp beneath the mastoid

processes and press up on the patients

head. This removes the weight of thepatients head on the neck.


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Distraction Test

Positive Test: If local pain increases,

suspect muscle strain, spasm, ligamentous

sprain, or facet capsulitis. Relief ofradicular pain indicates either foraminal

encroachment or a disc defect.


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Distraction Test

Shoulder Abduction Test


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(Bakodys Sign)

Procedure: The patient should abduct the

arm and place the hand on top of the head.

Positive Test: A decrease or relief of thepatients symptoms indicates a cervical

extradural compression problem (i.e.

herniated disc, epidural vein compression,or nerve root compression).

Shoulder Abduction Test


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(Bakodys Sign)

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