Cervical Spine Exam

Require

 

1.  Diagnose Myelopathy

- heel toe

- Rhomberg

- finger escape

- clench and release

- high tone

- inverted BR / Hoffmans

 

2.  Identify Neurology

 

Look 

 

Front

- Position of head & neck

- Torticollis

- SCM tumour

- wasting limbs

 

Side

- Kyphosis

- Webbed neck

 

Back

- Low posterior hairline

- Sprengel shoulder

- Wasting Peri-scapular

 

Gait 

 

Toe walking (S1)

Heel walking  (L4)

 

Toe-to-heel walking

- looking for balance difficulty

- ataxia

 

Romberg

- assess dorsal column / proprioception

- stand feet together, close eyes

- positive if sway or fall

 

Finger escape

- hold hands out

- try to keep LF together with other fingers

 

Clench and release

- should be > 20 times in 10 seconds

 

Feel

 

Spinous processes

Paravertebral - trapezius

Posterior triangle

Sternomastoid

 

Move

 

Forward flexion

- Chin to chest

- Total range of F/E is 130°

- Alanto Occiptial Joint (40% Nodding) / Subaxial (60% Forward translation)

 

Extension

- Plane of nose & forehead horizontal

 

Rotation

- Chin nearly to plane of shoulder 80°

- Atlantoaxial Joint (50%) / Subaxial (50%)

 

Lateral Flexion 

- Ear to shoulder with shrug 45°

- Occurs at lower Cervical vertebrae

 

Special Tests

 

Spurling's Sign

- Nerve root compression is confirmed by Spurling's sign 

- extension and rotation toward the symptomatic side reproduces the radicular symptoms

 

Thoracic Outlet Syndrome Tests

- Addsons

- Roos

 

Neurological Exam

 

Tone

 

High tone / clasp knife rigidity

 

Power

 

C5 - Deltoid / Biceps

C6 - Wrist Extension

C7 - Triceps

C8  - Finger Flexion

T1 - Interossei

 

Reflexes

 

C5 - Biceps

C6 - Brachioradialis

C7 - Triceps

 

Myelopathy reflexes

 

Inverted Brachioradialis

- tap on BR

- flexion of thumb and index finger

 

Hoffmann's reflex 

- forced flexion of MF DIPJ

- reflex finger and thumb flexion is elicited  

 

Scapulohumeral Reflex 

- tapping tip of spine of scapula

- brisk elevation of scapula & abduction of the humerus

- positive in > 95% of myelopaths

 

Jaw Jerk

- a cerebellar sign

- distinguishes myelopathy from cerebellum

 

Sensation

 

C5 - deltoid

C6 - lateral forearm, thumb

C7 - middle finger, posterior arm

C8 - little finger

T1 - medial forearm

T2 - medial arm