Upload
drkanthikirang
View
930
Download
2
Embed Size (px)
Citation preview
Examination of spine
Cervical region
Spine
• 33 bones
• 24 mobile individual segments– 7 cervical– 12 thoracic– 5 lumbar
• 2 lordotic 1 kyphotic
• Vertebral foramen
• Costal process
Anatomy of vertebra
• Body• 2 pedicles• 2 sup facets• 2 inf facets• Trans process• Lamina• Spinous process• Cord - canal
Relation of various parts of body
Anatomy of cervical spine
Ligaments of spine
Strap muscles of neck
Muscles of cervical spine
1. Semispinalis Capitus
2. Iliocostalis Cervicis
3. Longissimus Cervicus
4. Longissimus Capitus
Problems
• Strain & Sprain
• Ivdp
• Facet artropathy
• Infection– Septic– Tuberculous
• Vascular
History
• When/how• Intensity• Diurnal variation• Movements• Deglutation• Vomiting• Trauma • Constitutional symptoms
Neurological history
• Pain first/weakness first• Progression• Sensory• Motor• ADL affected• Tight/loose• Clonus• Jerky movements• Locomotion/list
Examination
• Look
• Touch
• Move
• Measure
Inspection
• Posterior– Inion– Vertebra prominens– Muscle spasm– Both shoulders– Scapula– Interscapular region
Anterior
• C3 – hyoid
• C4-5 - thyroid cartilage
• C6 – cricoid cartilage
• Sternum
• Notch
Palpation
• Bone– Spinous process
– Transverse process
– Hyoid
– Cricoid Ring
– Inion
– Scapula
• ROM • Flexion (80 to 90o)• Extension (70o)• Lateral flexion (L & R) (20 to 45o)• Rotation (L & R) (70 to 90o)• Shoulder elevation & depression
• PROM– Tissue stretch end feel for all
Examination
– Flexion• Scalenes• Longus coli
– Extension• Levator scapulae• Trapezius• Splenius, semispinalis, & longissimus cervicis
Examination
– Lateral flexion• Trapezius• Longus capitus• Sternocleidomastoid
– Rotation• Levator scapulae• Sternocleidomastoid
– Shoulder elevation
Sternomastoid
Extension strength
Flexion strength
Lateral flexion
Examination
• Peripheral joint scanning– TMJ– Shoulder girdle– Elbow– Wrist and hand
Special Tests
• Vertebral Artery Test
• Distraction
• Compression
• Valsalva Test
• Swallowing/cough
• Adson Test
• Spurling’s Sign (Foraminal Compression)
• Grip Strength
• Wiggle Fingers and Toes
• Pinch/Reaction to Pain
Vertebral Artery Test• With patient supine,
examiner supports pt’s head in both hands
• Examiner slowly extends, rotates, & laterally flexes pt’s head to the L then R.
• Hold each position for 30 sec
• Dizziness, blurred vision or slurred speech indicates complete or partial occlusion of vertebral artery
Distraction Test• Examiner begins by placing the
open palm of one hand under the pt’s chin with the other hand on the occipital bone at the base of the skull
• Gentle, linear, traction-like pressure is then exerted to lift pt’s head
• Positive test yields a relief of pain
• May be indicative of nerve root compression
Compression Test• Examiner presses down on the
crown of the pt’s head, looking for
apprehension or signs of pain
• Pt should be either seated or supine
• Positive test yields pain upon
compression and
• indicative of narrowed neural
foramen causing nerve root
compression
Spurling’s test
• Extend neck
• Rotate it to involved side
• Complains of pain
• Indicative of nerve root compression
Lhermite’s sign
• Flex c-spine and thoracic spine
• Parasthesia on trunk/limbs
Valsalva Maneuver
• The examiner should instruct the pt to “bear down” as if performing a bowel movement
• This movement increases interthecal pressure and is positive if pain is felt upon performance
• May be indicative of a herniated disc
Swallowing/Cough
• Pain upon swallowing or coughing is considered a positive test that may be indicative of cervical spine pathology or soft tissue swelling
Adson Test• Examiner begins by palpating the pt’s
radial pulse• Pt’s arm is then abducted, extended, and
externally rotated while the examiner continues to palpate the pulse
• Pt is instructed to take a deep breath and turn the head toward the arm (look “AD” me) being tested
• A disappearance of the radial pulse is a positive test that indicates a compression of the subclavian artery by the medial scalene muscle
Wiggle Fingers & Toes
The examiner instructs the patient to quickly flex and extend the fingers and toes.
Test is positive if athlete is unable to perform task and may indicate motor nerve involvement
Cervical spinal stenosis
• UMN below lesion level
• LMN above lesion level
Neurologic Exam: Sensory
C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of
shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and index
finger C7: Middle finger and palmar aspect of
hand C8: Small finger, ring finger, and medial
portion of palmar surface T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm
Neurologic Exam: Motor
C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation T1: Finger approximation
Neurologic Exam: Reflexes
Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)
ULT test 1
• C5-7 roots
Upto 1100
Circulatory
• Carotid
• Brachial
• Radial