Cervical Spine overview: Reading Notes and Lecture.
Is spondylosis or osteoarthritis more likely in a 50 year old patient presents in the clinic with dull, aching,
neck pain that is exacerbated by movement?
Spondylosis: seen in patients 25 or older. 60% of neck patients lter than 45 and 85% of those older than
65. Symptoms of osteoarthitis do not usally apear until age 60 or older.
What details in a patient history may lead you to suspect myofascial pain syndrome?
Myofascial pain syndromes dem- onstrate generalized aching and at least three trigger points, which
have lasted for at least 3 months with no history of trauma.45
At or above what nerve root level would you expect radicular symptoms to NOT travel down the arm?
Symptoms do not go down the arm for a C4 nerve root injury or for nerve roots above that level.
What is the clinical presentation for cervical radiculopathy?
Cervical radiculopathy, or injury to the nerve roots in the cervical spine, presents primarily with
unilateral motor and sensory symptoms into the upper limb, with muscle weakness (myotome), sensory
alteration (dermatome), reflex hypoactivity, and sometimes focal activity being the primary signs.
Acute radiculopathies are more associated with 1. ___________________ where chronic types are more
associated with 2.__________________
1. Disk herniation
2. Spondylosis
What symptoms are common in patients with cervical disk herniation?
Disc herniations in the cervical spine commonly cause severe neck pain that may radiate into the
shoulder, scapula and/or arm, limit ROM, and an increase in pain on coughing, sneezing, jarring, or
straining
What type of injury in the cervical region may lead to spastic weakness, paresthesia and possible
incoordination in one or both limbs?
Cervical myelopathy. May also have proprioceptive or sphincter dysfunction.
Why might laughing, coughing or sneezing increase symptoms in patients with neck pain?
Because these action lead to an increase in intrathoracic or intra- abdominal pressure = increased
pressure on damaged structures.
What does it mean when a patients neck pain is relieved by placing the hand/arm of the affected side on
top of the head?
Called Bakody's sign and is usually indicative with problems in the C4-C5 area
,Bilateral symptoms of numbness and tingling most often indicate what?
Systemic disease (diebetes, alcoholism) or a central space occupying lesion.
What are the sympathetic nervous system symptoms associated with traumatic neck injury such as
whiplash?
Tinnitus, blurred vision, photophobia, rhinorrhea, sweating, lacrimation, loss of strength.
Why is noting wether or not a patient is a "mouth breather" important?
Mouth breathing encourages forward head posture and increases activity of accessory respiratory
muscles.
What is the craniocervical flexion test?
The craniocervical flexion (CCF) test is a test of the deep cervical flexor muscle function.
How is the craniocervical flexion test performed?
The patient lies in supine with knees bent with head and neck in midrange, and a BP cuff is placed under
the cervical spine The pressure device is inflated to 20 mm Hg to "fill in" the lordotic curve of the cervical
spine. While keeping the head/occiput stationary the patient flexes the cervical spine by nodding the
head in five graded segments of increasing pressure (22, 24, 26, 28, and 30 mm Hg) and holds each for
10 seconds with 10 seconds rest between each segment. Superficial cervical muscles (e.g.,
sternocleidomastoid, platysma, hyoid) must remain relaxed during the test.
What are the normal responses to the craniocervical flexion test for young to middle aged adults?
Normally, young and middle-aged patients should be able to increase pressure to between 26 and 30
mm Hg and hold for 10 seconds without utilizing the superficial muscles
What are the normal responses to the craniocervical flexion test for older adults?
Elderly people are more likely to make greater use of the sternocleidomastoid muscle during the test.
What constitutes a positive result on the craniocervical flexion test?
the patient cannot increase pressure to at least 26 mm Hg, is unable to hold a contraction for 10
seconds, uses the superficial neck muscles, or extends the head
How is the performance index and activation score calculated for the craniocervical flexion test?
The performance index is the increase in pressure times the number of repetitions, while the activation
score is the maximum pressure achieved and held for 10 seconds.
What is the shoulder abduction (relief) test?
,This test is used to test for radicular symptoms, especially those involving C4 or C5 nerve roots. It is a
test for neurological symptoms
How is the shoulder abduction (relief) test performed?
The patient is sitting or lying down, and the examiner passively (or the patient actively) elevates the arm
through abduction so that the hand or forearm rests on top of the head
What constitutes a positive result on the shoulder abduction (relief) test?
A decrease in or relief of symptoms indicates a cervical extradural compression problem, such as a
herniated disc, epidural vein compression, or nerve root compression, usually in the C4-C5 or C5-C6
area.
Following a positive result on the shoulder abduction (relief) test, how can you determine the involved
segment?
Differentiation is by the dermatome (and possible myotome) distribution of the symptoms.
What does it mean if positioning during the shoulder abduction (relief) test increases symptoms?
Abduction of the arm decreases the length of the neurological pathway and decreases the pressure on
the lower nerve roots. If the pain increases with the positioning of the arm, it implies that pressure is
increasing in the interscalene triangle.
How is Lhermitte sign assessed?
The patient is in the long leg sitting position on the examining table. The examiner passively flexes the
patient's head and one hip simultaneously with the leg kept straight.
What indicates a positive result on the Lhermitte sign test?
A positive test occurs if there is a sharp, electric shock-like pain down the spine and into the upper or
lower limbs; it indicates dural or meningeal irritation in the spine or possible cervical myelopathy.
Coughing or sneezing may produce similar results.
What is the Soto Hall test?
Same as Lhermitte sign but the patient actively flexes the head to the chest while in supine lying
position.
Instability of the cervical spine is most often caused by what?
ligament damage (e.g., transverse ligament, alar ligaments), bone or joint damage (e.g., fracture or
dislocation) or weak muscles (e.g., deep flexors or extensors).
, What clues in a patients history point towards cervical instability as the cause of neck pain?
Sensations of instability, a lump in the throat, lip paresthesia, severe headache (especially with
movement), muscle spasm, nausea, or vomiting
What is true about manipulation and mobilization in the presence of instability?
If instability is present, mobilization and/or manipulation should not be performed.
What is the rotational alar ligament stress test?
The patient is in sitting position. The examiner grips the lamina and spinous process of C2 between the
finger and thumb. While stabilizing C2, the examiner passively rotates the patient's head left or right
moving to the "no symptom" side first.
What constitutes a positive result on the rotational alar ligament stress test?
If more than 20° to 30° rotation is possible without C2 moving, it is indicative of injury to the con-
tralateral alar ligament especially if the lateral flexion alar stress test is positive in the same direction.
How can you determine if increased rotation at C1-C2 is caused by an increase in the neutral sone in the
C1-C2 joint and NOT an alar ligament tear?
If the excessive motion is in the opposite direction between the rotational and lateral alar ligament
stress test its probably an increase in the neutral zone
What are the clinical yellow flags for heightened fear avoidance beleifs?
What are the clinical characteristics of fracture?
Clinically relevant trauma in adolescent or adult
Minor trauma in elderly patient Ankylosing spondylitis
What are the clinical characteristics of neaplasm?
Pain worse at night
Unexplained weight loss
History of neoplasm
Age of more than 50 or less than 20
years
Previous history of cancer
Constant pain, no relief with bed rest
What are the clinical characteristics of infection?
