This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.

1. BY: KHUSHALI JOGANI
The Sarvajanik College Of Physiotherapy
Rampura,Surat
ASSESSMENT OF
CERVICAL SPINE

2. Contents:
 Introduction
 Patient history
 Observation
 Palpation
 Examination of movement
 Special tests
 Diagnostic imaging
 References

3. INTRODUCTION
 Cervical spine consists of 37 joints.
 It has been said that cervical spine moves 600 times
per hour with normal activity.
 An area where stability is sacrificed for mobility.
 Divided into two areas: 1)cervicoencephalic
2)cervicobrachial
 Lordotic curve in cervical region develops at 3 to 4
months of age as child lifts head.
 At C4 to C5 interspace there is midpoint of curve.

4.  Line of gravity falls anterior to foramen magnum
 Abnormality from normal lordotic curve leads to
following:
 Reduction in cervical lordosis
 Increase in cervical lordosis

5. Resting position: slight extension
Closed packed position: full extension
Capsular pattern: side flexion and rotation equally
limited,extension

6. PATIENT HISTORY
 Age and gender
 Occupation
 Address
 Dominant side and affected side
 Chief complaint
 Mechanism of injury
 Onset of problem

7.  Location of Pain or other symptom when it
started
 Activities causing pain
 Duration and frequency of symptoms
 Has this occurred before and if so with what it
relieved ?
 Are the intensity,duration frequency increasing?
 Is pain periodic, episodic,occasional?
 Is pain associated with rest,activity,postures?

8.  Did the head strike to anything?
 Radiation of pain?
 Is pain affected by laughing, coughing, sneezing?
 Does the patient have headache,where, frequency
and does any position changes it?
 Is paraesthesia present?
 Tingling or numbness (unilateral or bilateral)?
 Any lower limb symptoms or difficulty in walking
or balance?

9.  Quality of pain and site and boundaries of pain?
 Is the condition improving?Worsening? Staying
the same?
 Activities aggravating or easing?
 Restriction of movement?
 Is there any difficulty in swallowing or voice
changes?
 Sleeping position and type of pillow?
 Any functional losses?
 Dizziness?

10.  Medical history
 Drug history
 Surgical history
 Economic history
 Social history
 Pain history
-VA Scale
-Mc Gill –Melzack pain questionnaire
-Thermometer pain rating scale

13. OBSERVATION
 Body built
 Assistive device
 Attitude of limb
 Posture( standing and sitting)
lateral
anterior
posterior

14.  Muscle spasm or any asymmetry?
 Facial expression?
 AnyTrophic changes?

15. PALPATION
 Tenderness
 Trigger points
 Any muscle spasm or swelling?
 Texture of skin and bony and soft tissues
-posterior
-anterior
-lateral

16. EXAMINATION
 Range of motion tests
 Active movements to be checked
-flexion, extension, rotation(right &left), side
flexion(right & left)
-combined movement
-repetitive movement
-sustained position
 Overpressure applied to check end feel
 Normal end feel is tissue stretch(all motions)

17. Tools used are
-Goniometer
-CROM
-Inclinometer

19.  Functional OA ROM
 Functional AA ROM

20.  Resisted isometric movements

21.  Peripheral joint scan
Active range & overpressure
-TM joint
-scapula
-Shoulder joint
-elbow joint
-wrist & hand
 MMT
-cervical muscles

22. -scapular muscles
 Myotomes (if weakness is due to neurological
involvement)
-neck flexion: C1-C2
-neck side flexion:C3
-shoulder elevation: C4
-shoulder abduction/shoulder lateral rotation: C5
-elbow flexion and/or wrist extension:C6
-elbow extension and/or wrist flexion:C7
-thumb extension and/or ulnar deviation:C8
-abduction and/or adduction of hand intrinsic:T1

25.  Sensory examination
Using light touch and pin prick on the
dermatomal levels on both ride and left side.
 Reflex evaluation
-biceps jerk(C5-C6)
-triceps jerk(C7)
-brachioradialis jerk(C6)
-jaw jerk
-hoffmann’s sign( if UMN suspected)

27.  Functional assessment
-activities of daily living
-functional strength testing
 If tightness is suspected muscle length test
should be done.
 Checking for locking maneuver and quadrant
position for shoulder .

28. SPECIAL TESTS
 Common test done in cervical spine are:
-foraminal compression test(spurling’s test)
-distraction test
-upper limb tension test
-shoulder abduction test
-vertebral artery (cervical quadrant) test

34.  Craniocervical flexion test
 Thoracic inlet syndrome test
-adson’s test
-costoclavicular
-hyperabduction
-3 min elevated arm exercise

35. DIAGNOSTIC IMAGING
 Plain film radiography
-lateral view
-open or odontoid view
-oblique view
 CT Scan
 MRI

36. REFERENCES
 Orthopaedic physical therapy
-DONNATELLIWOODEN (third edition)
 Orthopaedic physical assessment
-DAVID J.MAGEE(fifth edition)
 Orthopaedic examination, evaluation,&
intervention
-MARK DUTTON