EXAMINATION OF CERVICAL REGION AND DISORDER

1. EXAMINATION OF CERVICAL DISORDER
Presented by
Kaushal sinha
1st year PG
Dept. of panchakarma
SDM college of ayurveda
4/24/2016
1

2. CONTENT:-
 Introduction
 Region of spine
 Function of spine
 Examination of cervical spine
(A)General pysical examination
(B)Special test
(C)Range of movement
 conclusion
4/24/2016
2

3. INTRODUCTION
 33 vertebrae
 31 pair nerve roots
 23 disc
 Spinal cord-
Contained in epidural space
Network of sensory and motor
nerves
Firm, cord-like structure
Conus medullaris
Filum terminale
Cauda equina
Foramen
magnum
Conus
medularis
Cauda
equina
4/24/2016
3

4. SAGITTAL PLANE CURVES
 Cervical Lordosis 20°- 40
 Thoracic Kyphosis 20°-
40°
 Lumbar Lordosis 30°- 50
 Sacral Kyphosis
4/24/2016
4

5. REGION OF THE SPINE
 Cervical
 Upper cervical: C1-C2
 Lower cervical: C3-C7
 Thoracic: T1-T12
 Lumber: L1- L5
 Sacrococcygeal: 9 fused
vertebrae in the sacrum and coccyx
4/24/2016
5

6. FUNCTIONS OF SPINE:-
 Posture
 Spinal cord encasement
 Weight transmission
 Posture
 Vital organs back support
 Muscles attachment
4/24/2016
6

7. WHAT IS CERVICAL SPINE
Consist of 7 vertebra
8 nerves
Give two plexuses:-
Cervical plexus ( C1-C5)
Phernic ( C3,C4,C5
Lesser occipital (C2)
Supraclaviclular ( C3,C4)
brachial plexus ( C5-T1)
mucocutanous n (C5-C7)
axillary n (C5-C6)
median n (C5-T1)
radial N (C5-T1)
ulnar n (C8-T1)
4/24/2016
7

8. CERVICAL DISORDER
 Cervical spondylosis
 Cervical radiculopathy
 Cervical myelopathy
 Cervical Strain/spasm
 Cervical Sprain
 Cervical Stenosis
 HNP(Herniated Nucleus pulposus)
 Cervical Cord Neuropraxia
 Fractures/subluxation etc.
4/24/2016
8

9. COMMON CONDITIONS AFFECTING THE
CERVICAL SPINE
4/24/2016
9

10.  Herniated disc- The two most common levels in the cervical spine to herniate are the C5
- C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the
C4 - C5 level, and rarely the C7 - T1 level may herniate4
Cause- some sort trauma & injury
 Bone spur- Cervical osteophytes are bone spurs that grow on any of the seven
vertebrae in the cervical spine (neck), involving the spine from the base of the skull to the
base of the neck (C1 - C7 vertebrae)
Cause- inflamed or damaged tissue, cervical osteoarthritis, cervical spondylosis
Other types of arthritis, traumatic injury, and poor posture
 Narrow disc space- cervical foraminal stenosis (narrowing of the cervical disc space)
may arise without any disc herniation. The majority of symptoms with this type of
cervical stenosis are usually caused by one nerve root on one side
4/24/2016
10

11. EXAMINATION OF CERVICAL SPINE
 History
 General Examination
 Inspection
 Palpation
 Special Test
 Range of Movement
4/24/2016
11

12. EXAMINATION TECHNIQUE:-
 Introduce yourself
 Ask permission to perform examination
 Explain the patient appropriately
 The patient must be exposed properly
 Tell the patient to let you know if anything you do
uncomfortable and painful
 When female patient make sure that female nurse
& assistant is present.
4/24/2016
12

13. HISTORY
 Male / Female
 Occupation
 Socio economic class
 Presenting chief complaints
 History of presenting ilness
 Treatment history
 Past history
 Personal history
 Family history
4/24/2016
13

14. ASK FOR…
 H/o Trauma
 H/o constitutional symptoms
 H/o Hemoptysis
 H/o Respirory symptoms,dysponea
 H/o Other joint involements
 H/o Pelvic inflammatory
 Treatment histoy
 Immunization history BCG,polio
4/24/2016
14

15. PAST HISTORY
 Similar complains
 Prolonged history
 Previous surgery
 DM
 HTN
 Tuberculosis
 Hematological disorder
 Any neurological disorder
4/24/2016
15

16. PERSONAL HISTORY
 Smoking
 Alcohol
 Drug addiction
 Diet
 Bowel bladder habbit
 Appetite
 Menstrual history in female
4/24/2016
16

17. FAMILY HISTORY
 Similar illness
 Tuberclosis
 HTN
 DM
4/24/2016
17

18. INSPECTION
(A) Standing
Look from the side
normal spine
> cervical
lordosis
 Increased lordosis
– muscular weakness or
imbalance
 Lessened lordotic curve -
muscular spasm/guarding
and/or nerve root
impingement
4/24/2016
18

19. (B) Position of Head Relative to Shoulders
 Head should be seated symmetrically on cervical
spine
 Lateral flexion -
from unilateral spasm of muscles – strain and/or
spasm (guarding)
 Rotation –
from unilateral spasm of sternomastoid muscle –
strain and/or spasm (guarding) or torticollis
4/24/2016
19

20. PALPATION
 Local rise in temperature
 Palpate all spinous process
 Prominent spinous process
Feel
→ The midline spinous
processes
→ The paraspinal soft tissues
→ The supraclavicular fossae –
for cervical ribs or enlarged
lymph nodes
→ The anterior neck structures
including the thyroid
4/24/2016
20

21. SPECIAL TESTS
 Cervical spine :
 Spurling test
 Compression test
 Distraction test
 Valsalva test
 Swallowing test
 Adson test
 Range of motion:
 Active
 Passive
4/24/2016
21

22. SPECIAL TEST:-
Movement
(A) Flexion
- ask the patient to
bend the head
forwards
- chin should be able
to touch the chest
- normal : 80°
(B) Extension
- ask the patient to look
up and back
- normal : 50°
4/24/2016
22

23. RANGE OF MOTION TESTING
Active:-
 Best done in sitting or
standing
 Flexion – touch chin to
chest
 Extension – look straight
above head
 Lateral flexion –
approximately 45
degrees
 Rotation – nose over tip
of shoulder
Passive:-
 Best done laying supine
 Flexion – firm end feel
 Extension – hard end feel
(occiput on cervical
spinous processes)
 Lateral flexion – firm end
feel (stabilize opposite
shoulder)
 Rotation – firm end feel
4/24/2016
23

24. (C) Lateral flexion
- ask the patient to touch
his shoulder with the ear
- involve atlanto-axial and
atlanto-occipital joints
- normal : 45°
(D) Rotation
- ask the patient to look
over his shoulder
- normal : 80°
- restricted and painful in
cervical spondylitis
4/24/2016
24

25. COMPRESSION TEST
 Testing for compression of cervical
nerve root or facet joint irritation in the
lower cervical spine
 Ask the patient seat the table
 Patient head is natural,therapist stands
behind patient
 Positive sign –
 Radiating pain or other neurological
sign in the same side arm(nerve root)
and pain local to the neck or shoulder
 A narrowing of neural foramen,
pressure on the facet joints or muscle
spasm can cause increase pain upon
compression
4/24/2016
25

26. SPURLING TEST
 Same positioning as cervical
compression test
 Compression of a cervical nerve
root or facat joint irritation in the
lower cervical spine
 Patient slowly
extends,sidebend,and rotates
the head of affected side.
 Therapist carefully compression
downword on the head of patient
 Positive sign:-
Radiating pain or other
neurological sign in the same
side arm(nerve root) and pain
local to the neck or shoulder
(facet joint irretation)
4/24/2016
26

27. DISTRACTION TEST  To relive the pressure on the
cervical roots (may be used
after spurlling or
compression test)
 Place the open palm of one
hand under the pt’s chin,
and the other hand is upon
occiput & tempolallis
 Then, gradually lift
(distract) the head to
remove its weight from the
neck
 To demonstrate the effect
that neck traction might
have help in relieving the
pain by decreasing pressure
on the joint capsules around
the facet joints.
4/24/2016
27

28. VALSALVA TEST
 Ask pt to hold his breath and bear
down as if he were moving his bowels
 Then, ask whether he feels any
increase in pain and describe the
location
 This test increase intratechal pressure
 If a space occupying lesion, such as a
herniated disc or a tumor present in
cervical canal, pt may develop pain in
cervical spine secondary to increase
pressure
 The pain also may radiate to the
dermatome distribution of cervical
spine pathology
4/24/2016
28

29. SWALLOWING TEST
 Difficulty or pain upon
swallowing can
sometimes caused by
cervical spine pathology
such as :
 Bony protuberance
 Bony osteophytes
 Soft tissue swelling
due to hematomas,
infection or tumor in
ant portion of cervical
spine
4/24/2016
29

30. LHERMITTE’S SIGN
 This sign detects protrusion
of cervical intervertebral disc
or an extradural spinal
tumour irritating the spinal
duramater.
 The patient sits on an
examining table,now the
head of the patient is bent
down passively(flexion of
cervical spine ) and
simultaneously the lower
limbs are lifted(flexing the hip
joints) keeping the knees
straight. This will causes
sharp pain radiating down the
spine and to both the
extremities.
4/24/2016
30

31. ADSON TEST
 Pull the arm downwards
 Palpate the radial pulse
 Turn the pt’s head to the same side and extend the neck
 Abduct, extend, and laterally rotate the shoulder.
 From this position, have the patient take a deep breath and
hold
 Feel the radial pulse
 Fading of the radial pulse indicates positive thoracic outlet
obstruction
4/24/2016
31

32. CONCLUSION:-
 Facet joint spondylosis and herniation of the intervertebral
disc are the most common causes of nerve root compression.
 Understanding the pathophysiology, diagnosis, treatment
indications, and treatment techniques will lead to rapid
diagnosis and improved patient care.
 This knowledge is important for all practitioners. Rapid
diagnosis and treatment will lead, ultimately, to a greater
chance for early recovery for the patient affected by this
condition.
4/24/2016
32

33. Thank you......
4/24/2016
33