EXAMINATION OF CERVICAL DISORDER

4/24/2016
Presented by
1 Kaushal sinha
1st year PG
Dept. of panchakarma
SDM college of ayurveda
CONTENT:-

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 Introduction
 Region of spine

 Function of spine

 Examination of cervical spine

(A)General pysical examination

(B)Special test
(C)Range of movement
 conclusion

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 INTRODUCTION
Foramen

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 33 vertebrae magnum
 31 pair nerve roots
 23 disc
 Spinal cord-
Contained in epidural space
Network of sensory and motor Conus
nerves medularis
Firm, cord-like structure
Cauda
Conus medullaris equina
Filum terminale
Cauda equina
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 SAGITTAL PLANE CURVES

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 Cervical Lordosis 20°- 40

 Thoracic Kyphosis 20°-

40°

 Lumbar Lordosis 30°- 50

 Sacral Kyphosis
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 REGION OF THE SPINE

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 Cervical
 Upper cervical: C1-C2
 Lower cervical: C3-C7

 Thoracic: T1-T12

 Lumber: L1- L5

 Sacrococcygeal: 9 fused
vertebrae in the sacrum and coccyx
FUNCTIONS OF SPINE:-

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 Posture

 Spinal cord encasement

 Weight transmission

 Posture

 Vital organs back support

 Muscles attachment 6
WHAT IS CERVICAL SPINE

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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) 7
 CERVICAL DISORDER

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 Cervical spondylosis
 Cervical radiculopathy

 Cervical myelopathy

 Cervical Strain/spasm

 Cervical Sprain

 Cervical Stenosis

 HNP(Herniated Nucleus pulposus)

 Cervical Cord Neuropraxia

 Fractures/subluxation etc.

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COMMON CONDITIONS AFFECTING THE
CERVICAL SPINE

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 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
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cervical stenosis are usually caused by one nerve root on one side
 EXAMINATION OF CERVICAL SPINE

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 History
 General Examination

 Inspection

 Palpation

 Special Test

 Range of Movement

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EXAMINATION TECHNIQUE:-

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 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.

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 HISTORY

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 Male / Female
 Occupation

 Socio economic class

 Presenting chief complaints

 History of presenting ilness

 Treatment history

 Past history

 Personal history

 Family history

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 ASK FOR…

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 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

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 PAST HISTORY

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 Similar complains
 Prolonged history

 Previous surgery

 DM

 HTN

 Tuberculosis

 Hematological disorder

 Any neurological disorder

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 PERSONAL HISTORY

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 Smoking
 Alcohol

 Drug addiction

 Diet

 Bowel bladder habbit

 Appetite

 Menstrual history in female

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 FAMILY HISTORY

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 Similar illness
 Tuberclosis

 HTN

 DM

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 INSPECTION

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(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 18
impingement
(B) Position of Head Relative to Shoulders

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 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
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 PALPATION

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 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
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 SPECIAL TESTS

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 Cervical spine :  Range of motion:
 Spurling test
 Compression test  Active
 Distraction test  Passive
 Valsalva test
 Swallowing test
 Adson test

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SPECIAL TEST:-

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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° 22
 RANGE OF MOTION TESTING

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Active:- Passive:-
 Best done in sitting or  Best done laying supine

standing
 Flexion – firm end feel
 Flexion – touch chin to
chest  Extension – hard end feel
(occiput on cervical
 Extension – look straight spinous processes)
above head
 Lateral flexion –  Lateral flexion – firm end
approximately 45 feel (stabilize opposite
degrees shoulder)
 Rotation – nose over tip
of shoulder  Rotation – firm end feel 23
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(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
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 COMPRESSION TEST

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 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 25
compression
SPURLING TEST

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 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)

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DISTRACTION TEST  To relive the pressure on the
cervical roots (may be used

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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
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the facet joints.
VALSALVA TEST

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 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 28

dermatome distribution of cervical
spine pathology
SWALLOWING TEST

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 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
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LHERMITTE’S SIGN

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 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.
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ADSON TEST

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 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 31
obstruction
CONCLUSION:-

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 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.

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

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