Cervical Spine Evaluation

Name:__________________ Age:_________ NDI____________________ 9 points = relevant change PMH:___________________________ Occupation:______________________ Reason for PT:________________________

Previous Episode:______________________________ Current Medications:________________________ Have you had recent diagnostic imaging? Y

N _____________________

MOI / When and How did you first notice your pain? ________________________________ Do you do something?_________________________________________ What Functional Limitations do you have: Sitting___________ Sleep__________ Reaching_________ ADL(brush, dress, Hair)________ ___________________ Transfers_____________________________ Red Flags/Vitals: Any Difficulty Swallowing? Y N Any Increased Pain at night or night sweats? Y Any Changes in Sight, Smell Vision or Balance? Y Pain/Symptom Assessment: Please point to where your pain is on your body? What words would you use to describe your pain? Work Responsibilities Y N

Hobbys__________________________________

N N

NPRS in the last 72 hours: Best:_____________ /10 NPRS Start of Exam:___________/10

Worst_____________/10

Finish:___________/10

Is there any position that relieves your pain?__________________________________________

What is your goal for PT?__________________________________ Any other medical condition not mentioned?_______________________________________

Objective Findings
Observation: Standing & Sitting (Anterior, Lateral & Posterior)

1) Postural / Static: Scapular Positioning__________ Thoracic Kyphosis__________ _____ shoulder positioning_____________ Head forward______________ Hips______________ Anterior: Head in Midline, Nose with manubrium Lateral: Ears with Acromion Posterior: Ears to Iliac Crest Can pt. correct posture? Poor/Fair/ Goood 2) Skin Integrity (if appropriate): Swelling / Discoloration

Rom:

SYMPTOM RESPONSE!!!!!!!!

Cervical spine movement: Visual estimate of movement loss WNL Mild Loss Moderate Severe Comments Flexion 45 Extension 70-85 LLF 20-45 RLF 20-45 Rotation R 60 Rotation L 60 Retraction Protraction
Shoulder Screening to see compensation

Quality of movement:________________________________________ Curve reversal / provokes symptoms Strength Impairments - NRI and Stabilize (R vs L) Myotomes testing C1-2- Neck flexion _________________/5 C3- Neck SB___________________/5 C4- Shoulder Elevation__________________/5 C5 Shoulder Abduction_________________/5 C6 Elbow flexion & wrist ext ________________/5 C7- Wrist Extension & wrist flex_______________/5 C8-Long Finger flexors__________/5 T1- Interossei (adduct fingers) _______________/5 If anything is weak do MMT for Deep neck flexors, Lower and mid Traps, rhomboids, Stratus Anterior (rows I s pulls), pecs, possible Upper Cross Syndrome. Reflexes (DTR) 0-4: 0 absent / 2 normal / 4 hyperactive with clonus(NRI) Compare R & L Biceps tendon (C5) ___________ Brachioradialis (C6)____________ Triceps (C7)____________ Sensation (Dermatomes) C3-4 Shoulder C5- lateral arm C6 Lateral forearm digits 1-2 C7 Middle finger 3rd digit C8- Medial (ulnar hand) digits 4-5 T1- medial arm Peripheral Nerve

Axillary nerve deltoid patch Musculocutaneous nerve-Lateral forearm

Radial nerve lateral hand and dorsal surface Median nerve- lateral hand on palmer surface Ulnar- medial hand on dorsal and palmer surfac

Palpation and Joint play (Identify painful segments) tenderness and segmental Palpation: EOP, Mastoid, spinous processes and transverses processes of Cervical and Thoracic Vert Hypomobility: Y N mobilize WNL Hypermobility: Y N stabilize Cervical Distraction Decrease SX: Myofascial: BE PURPOSEFUL Upper Trap__________ Levator Scap________ Scalenes_________ Rhomboids __________ Mid trap__________ Latissimus dorsi___________

N Mild, Moderate, Severe Tenderness

Sub-occipital_______________ Special Tests: Monitor pt. response. VBI: at risk pt, HTN, vessel abnormalities, migraine. Rotation has potential occlusion of blood flow Thought to be spontaneous and is a rare event however it s a quick test and we will cross our t s and dot our lower case j s Pt seated arms out extend c spine and rotate look behind hold 20-30 sec looking for vertigo nausea, blurred vision Disc with Radicular symptoms: may result in nerve root impingement consistant with patterns Test Positive Negative Comments Spurlings A Cluster rot to involved side <60 Spurlings B ULTT A: Scap dep, ABD, Sup, wrist Cluster finger Ext, ER Elbow Ext, Cerv LF Cluster Cervical distraction test Shoulder Depression test Bakody s Sign Classic presentation: neck pain with UE radicular symptoms, Limited neck rom, antalgic posture Intervention: determine if pt can centralize symptoms: Y centralize introduce stab N: address acute introduce stab . Monitor for progressive neuro loss failure to improve MRI Pain impairments: modalities and manual traction as indicated Non Descript Neck pain ( extension maximizes mechanical extension in the lower spine.) Postural syndrome typical pt < 30 years old, sedentary no pathology present. Pt ed with body mech Dysfunction: pain at end ranges, Pain goes away in neutral, poor posture Derangemnent Classifications (anatomical disruption within the spinal motion segment) RAPID AND LASTING CHANGES IN pt PAIN Retraction and Extension in standing, Retraction and extension with towel, Extension in lying manual tech by therapist.
D1 NP no lateral component Reduced with ext D3 NP + pain above the knee, no lateral component reduced with ext D5 NP + pain below the knee, no lateral component reduced with ext D2 NP lateral component reduced with ext and lateral component D4 NP lateral component reduced with pain above the knee with ext and lateral movement D6 NP lateral component with pain below the knee reduced with ext and lateral movement D7 NP of anterior pain reduced with flexion

Neck Pain consistent with postural Strain or stress: Upper Cross Syndrome Short: Pecs, upper trap, Lev scap, scalenes, scm, suboccipitals. Weak, Lower and Mid traps, Rhomboids, Serratus ant, deep neck flexors and extensors of the upper extremity

Test Positive Negative Comments Spurlings A ULTT A Bakody Sign Shoulder Depression test/ brachial plexus test Cervical distraction test/ traction in seated Impairments: pain, dec ROM segmental, Altered muscle tension, Dec strength, postural adaptations Interventions: Prom Arom, hold relax, strengthening exercises, mobilizations in the t spine Functional Limit_ Dec tol to sitting, dec tol to reaching, Limitations to ADL s, Sleep disruption, Dec ability to perform work activities. Brachial Plexus Injury: upper c5, c6 erb duchenne and lower c8,t1 klumpke MOI: parent or athletic inj
Test Shoulder Depression test Spurlings A Positive Negative Comments Should light this up

Exam findings: multiple nerve root signs, myotomes, Dermatomes (may not see changes) and reflexes Intervention: Protect the GH and RC .observe and monitor transition into therex, monitor realistic expectations Safety first OA of the cervical spine: gradual onset/periodic episodes ULTT A Spurlings A Cervical distraction test

Should be positive

Presentation: Worse in the AM and prolonged postural position, better with easy activity negative neuro sign unless spinal stenosis Limited ROM. Interventions: Acute s/s manual traction, modalities, optimize pain free rom, Realistic expectations Therex=postural strengthening, stab and functional aerobic exercise

Cervicogenic Headache: prolonged postural or repetitive activity pain wrapping around head Test Spurlings A ULTTA Palpation is key
Cervical distraction test

Positive

Negative

Comments

Intervention: Pain-modalities and manual traction Pt education and Address mechanics of specific postural imbalances (upper cross pattern common)

Make sure its not migranes unilateral symptoms/nausea

.or subarachnoid hemorrhage

Torticollis: Spasm of SCM and associated muscles Severe limitation of contralateral LF and Ipsi rotation
ULTT A Spurlings A Cervical distraction

Postural deviation ipsilateral LF and contralateral rotation, negative neuro MMT pain with contraction of involved SCM Interventions: modalities and manual tx for pain ..Introduce ROM as tolerated PT ED. Impairments: dec ROM, dec strength, increased pain, dec tone

Functional Limit: seated position/ driving, lifting, sleep, ADL, reaching

STG, Address impairments/functional limitations NDI, NPRS, Inc ROM, Sleep, cervical stab better, address activities consistent with upper cross LTG: return to work, return to sport

Cervical Good to Know

Movement Neck Flx/Ext LF / tape LF Goni Rotation/Tape Rotation/Goni Position Seated Seated Seated Seated Seated Axis Lobulbe of ear Distance between C7 spinous process Distance between Midpointt of top of head Stationary Perpendicular to floor pointing up Mastoid process Along spine perp to floor Chin Parallel to line going two acromion Movable Parallel to the base of the nares Lateral Acromion Midpoint of head Lateral Acromion Aligned with nose

MMT
Muscle Biceps Position Seated with arm flex to or slightly into flexion Seated arm supported with wrist in extension Seated arm supported wrist into Flexion Fingers in flexed position Fingers together Fingers apart Cross Test movement forearm Flexion Wrist extension Wrist Flexion Finger flexion Palmer add Dorsal ABD Syndrome Applied force Into extension Into Flexion Into Extension Into ext of fingers Into abd pull fingers apart Push fingers together Root C5 C6 C7 C8 T1 T1

ECRL/ECRB FCR/FCU FDS FDP Interossei adduct and abduct digits Upper Rhomboids / Middle Traps Deep Neck Flexors Lat Dorsi Serratus Anterior

Muscles that would be tight Pec Major / pec minor , upper trap, Levator Scap, suboccipitals, SCM