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Cervical SpineOve Indergaard MSc MCSP HPC
Anatomy
Spinal Movement
Anatomy
Anatomy
Anatomy
Objective Examination• Observation: posture, compensatory
postures, atrophy/spasm
• Movement: Active and Passive, Quality, Range and production of symptoms
• Neurological Assessment: Myotomes, Dermatomes, Reflexes, AND tests
• Special Tests: Spurlings, Brachial plexus, Thoracic outlet
• Neurological assessment: relexes, SLR, PKB, myotomes, dematomes, plantar reflexes
Posture
Posture
Movement Testing
• Cervical Spine:
• Flexion
• Extension
• Rotations
• Sideflexions
• Supine tests
• Thoracic Spine
• Shoulders
Neurological Testing
Dermatomes
Special Tests
• Spurlings test / Foraminal Compression Test
PositivePositive Pain in UE toward side laterally flexedPain in UE toward side laterally flexed postive test 95% sensitive to nerv root postive test 95% sensitive to nerv root
pathologypathology IndicationsIndications
Pressure on nerve rootPressure on nerve root ConsiderationsConsiderations
+ vertebral artery test+ vertebral artery test Osteoarthritis, osteoporosis, spinal Osteoarthritis, osteoporosis, spinal
stenosis or cervical spine instabilitystenosis or cervical spine instability
Foraminal Distraction
PositivePositive Existing complaints disappear or Existing complaints disappear or
decreasedecrease IndicationsIndications
Nerve root impingement during normal Nerve root impingement during normal postureposture
Increase in pain may indicate muscle or Increase in pain may indicate muscle or ligament injuryligament injury
Special Tests
•Brachial plexus
PositivePositive Radiating pain on side tilting Radiating pain on side tilting awayaway
from = from = brachial plexusbrachial plexus Radiating pain on side tilting Radiating pain on side tilting
towardstowards = = nerve root impingementnerve root impingement ConsiderationsConsiderations
fracturefracture
Special Tests•Thoracic Outlet:
Allen’s TestAllen’s TestPositivePositiveDiminished radial pulseDiminished radial pulseIndicationsIndicationsThoracic Outlet SyndromeThoracic Outlet Syndrome
Adson’s TestAdson’s TestPositivePositiveReduced or altered radial pulseReduced or altered radial pulseIndicationsIndicationsThoracic Outlet SyndromeThoracic Outlet Syndrome
Thoracic Outlet Cont
PositivePositive Inability to maintain test Inability to maintain test
positionposition Diminished hand functionDiminished hand function Loss of sensation in UELoss of sensation in UE
IndicationsIndications Thoracic Outlet Thoracic Outlet
SyndromeSyndrome
Management of Acute Neck Injuries (whiplash)
Whiplash cont
Management of Chronic Neck Pain
Intervention & Treatment Recommendations evidence based guidelines (JOSPT 2008)
Cervical Manipulation/Mobilisations alongside coordination, strengthening, & endurance exercises (Grade: A)
Patient Education and Reassurance are important throughout treatment. (Grade: A)
The use of upper quarter and nerve mobilisation procedures can be useful in the treatment of patients with neck pain. (Grade: B)These interventions have been shown beneficial and are even more effective when paired with manual therapy and exercise.
Use of Thoracic Mobilisation/Manipulation (Grade: A)The use of thrust manipulations and mobilisations have been shown more recently (2012) that it can reduce symptoms in patients with neck and neck related arm pain.
Use of Stretching (Grade: C) Stretching involved musculature can be beneficial for patients with neck pain.
Activity Limitations (Grade: F)The patient should be limited to functional activity that does not cause an increase in symptoms throughout the treatment period. This helps the clinician to assess changes in the patients level of function during an episode of care.
Common exercises
• Acute: ROM exercises
• Chronic: Dysfunction specific, can be stretches, motor control, stabilisations, general strength
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