exam cervical usa
TRANSCRIPT
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Cervical Orthopedic Tests
Chapters 3 & 4
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Tenderness Grading Scale
Grade Imild tenderness to palpation
Grade IImild tenderness with grimace
and flinch to moderate palpation
Grade IIIsevere tenderness with
withdrawal
Grade IVsevere tenderness with
withdrawal from noxious stimuli
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Cervical Palpation (Anterior)
Sternocleidomastoid
Carotid arteries
Supraclavicular Fossa
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Cervical Palpation (Posterior)
Trapezius
Cervical intrinsic musculature
Spinous processes / facet joints
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Cervical Range of Motion
Take a thorough history to be certain thatthese motions will not adversely affect the
patient.Trauma causing fracture, dislocation, orvascular compromise would becontraindications to performing these tests.
Note limited range of motion.
Note pain location and character.
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Normal Cervical ROM
Flexion50 degrees or more
Extension60 degrees or more
Lateral flexion45 degrees or more
Rotation80 degrees or more
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Cervical Resistive Isometric
Testing
Evaluate muscle strength and state.
Weakness may indicate neurological
dysfunction.
Pain indicates muscle dysfunction such as a
strain.
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Muscle Grading Scale
5Complete range of motion against gravity withfull resistance.
4Complete range of motion against gravity withsome resistance.
3Complete range of motion against gravity.
2Complete range of motion with gravity
eliminated.1Evidence of slight contractility.
0no evidence of contractility.
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Vertebrobasilar Circulation
Assessment
Vascular Insufficiency may be aggravated
by positional change in the cervical spine.
Assessment of the vertebrobasilarcirculation must be done if cervical
adjustment or manipulation is to be
performed.
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Predispositions to
Cerebrovascular Accidents
Headaches, migraine
Dizziness
Sudden severe head or neck pain
Hypertensive
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Predispositions to
Cerebrovascular Accidents
Cigarette smoking
Oral Contraceptives
Obesity
Diabetes
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Cerebrobasilar Testing
Positional change in the cervical spine
compresses the vertebral artery at the
atlantoaxial junction on the side opposite ofrotation.
In the normal patient, the diminished blood
flow does not cause any neurologicalsymptoms, such as dizziness, nausea,
tinnitus, faintness, or nystagmus.
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Clinical Signs and Symptoms of
Cerebrovasular Episodes
Vertigo, dizziness, giddiness, light-
headedness
Drop attacks, loss of consciousness
Diplopia
Dysarthria
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Clinical Signs and Symptoms of
Cerebrovasular Episodes
Dysphagia
Ataxia of gait
Nausea, vomiting
Numbness on one side of the face
Nystagmus
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Barre-Lieou Sign
Procedure: Patient rotates head from one
side to the other.
Positive Test: Vertigo, dizziness, visualblurring, nausea, faintness, nystagmus.
Structure affected: Vertebral artery on the
same side of head rotation. Considerpatency of the carotid arteries and the
communicating cerebral artery circle.
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Barre-Lieou Sign
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Vertebrobasilar Artery
Functional Maneuver
Procedure: Palpate and auscultate the
carotid arteries for pulsations and bruits.
Instruct the patient to rotate andhyperextend the head.
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Vertebrobasilar Artery
Functional Maneuver
Positive Test: If pulsation or bruits are
present at either the carotid or subclavian
arteries the test is positive.Structures Affected: It may indicate
stenosis or compression of the carotid or
subclavian arteries.
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Vertebrobasilar Artery
Functional Maneuver
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Maignes Test
Procedure: Patient extends and rotates the
head and holds that position for 1540
seconds. Repeat on opposite side.Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, orcarotid artery stenosis or compression.
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Maignes Test
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Dekleyns Test
Procedure: Patient supine, head off table.
Instruct pt. to hyperextend and rotate head.
Hold 15 to 30 seconds. Repeat opposite.Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, orcarotid artery stenosis or compression.
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Dekleyns Test
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Hautants Test
Procedure: Pt. Seated, eyes closed, extend
arms to front with palms up. Pt. extend and
rotate head.Positive Test: Patient loses balance, drops
arms, and will pronate the hands.
Structures Affected: Vertebral, basilar, orcarotid artery stenosis or compression.
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Hautants Test
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Underburgs Test
Procedure: Pt. standing. Close eyes and
assess equilibrium. Stretch arms and
supinate hands. Then pt. marches in place.Then pt. extends and rotates head while
marching. Then opposite side.
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Underburgs Test
Positive Test: Patient loses balance, arms
drift, hands pronate. Vertigo, dizziness,
visual blurring, nausea, faintness, andnystagmus.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
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Underburgs Test
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Hallpikes Maneuver
Procedure: Pt. supine with head extended
off table. Support head and move it into
extension. Then laterally flex and rotate.Hold 15 to 40 seconds. Repeat opposite.
Then hang head in free hyperextension.
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Hallpikes Maneuver
Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, orcarotid artery stenosis or compression.
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Hallpikes Maneuver
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Hallpikes Maneuver
Cli i l Si d S t f
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Clinical Signs and Symptoms of
Cervical Strain or Sprain
Cervical and upper back pain
Cervical and upper back stiffness
Cervical and upper trapezius tightness
Reduced cervical range of motion
Cervical extensor spasm
Diff ti ti B t St i
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Differentiating Between Strain
and Sprain
Cervical strainis an irritation and spasm of
the musclesof the cervical spine with or
without partial muscle fiber tearing.Cervical sprainis a wrenching of the joints
of the cervical spine with partial tearing of
its ligaments.
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Categories of Strain
Mild: Slight disruption of muscle fibers
with no appreciable hemorrhage and
minimal amounts of swelling and edema.
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Categories of Strain
Moderate: Laceration of muscle fibers with
an appreciable amount of hemorrhage into
the surrounding tissues and a moderateamount of swelling and edema.
Severe: Complete disruption of the muscle
tendon unit, possibly with tearing of thetendon from the bone or a rupture of the
muscle through its belly.
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Categories of Sprain
Mild: Slight tears of a few ligamentous
fibers.
Moderate: More sever tearing ofligamentous fibers but not complete
separation of the ligament.
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Categories of Sprain
Severe: Complete tearing of a ligament
from its attachments.
Avulsion: A ligament that attaches to abone is pulled loose with a fragment of that
bone.
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ODonoghues Maneuver
Procedure: Patient seated. Put the cervical
spine through resisted range of motion, then
through passive range of motion.Positive Test: Pain during resisted range of
motion or isometric muscle contraction
signifies muscle strain. Pain during passiverange of motion may indicate a sprain of
any of the cervical ligaments.
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ODonoghues Maneuver
Structures Affected: Cervical spinal
muscles and/or cervical spinal ligaments.
Since resisted range of motion mainlystresses muscles and passive range of
motion mainly stresses ligaments, you
should be able to determine between strainand sprain or a combination thereof.
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ODonoghues Maneuver
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Spinal Percussion Test
Procedure: Patient seated. Head slightly
flexed, percuss the spinous process and
associated musculature of each cervicalvertebrae with a reflex hammer.
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Spinal Percussion Test
Positive Test: Local pain may be a
fractured vertebra with no neurological
compromise. Radicular pain may be afractured vertebra with neurological
compromise or a disc lesion with
neurological compromise. A ligamentous
sprain could also elicit pain upon percussion
of the spinous processes.
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Spinal Percussion Test
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Soto-Hall Test
Procedure: Patient Supine. Press on the
patients sternum with one hand. With the
other hand, passively flex the patients headto the chest.
Positive Test: Local pain could indicate
ligament, muscular, ossous pathology orcervical cord disease. Suspect disc defect
with radicular symptoms.
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Soto-Hall Test
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Rusts Sign
Procedure: A patient with severe injury to
the upper cervical spine will grasp the head
with both hands to support the weight of thehead on the cervical spine. The supine
patient will support the head while
attempting to rise.
Positive Sign: The patient stabilizes the
head. It might include slight traction.
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Rusts Sign
Structures Affected: This could represent
severe muscular strain, ligamentous
instability, posterior disc defect, uppercervical fracture, or dislocation.
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Rusts Sign
Cervical Instability Clinical
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Cervical Instability Clinical
Signs and Symptoms
Severe cervical pain.
Patient stabilizing the head.
Little or no cervical motion.
Severe cervical muscle spasm.
Upper extremity neurological dysfunction.
Lower extremity neurological dysfunction.
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Space-Occupying Lesions
Clinical Signs and Symptoms
Cervical pain.
Upper extremity neurological symptoms. Lower extremity neurological symptoms.
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Valsalvas Maneuver
Procedure: Have the patient bear down as if
defecating and focus the bulk of the stress
on the cervical spine. Ask if the patientfeels pain and have them point to the
location.
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Valsalvas Maneuver
Positive Test: Local pain with increased
pressure could indicate a space-occupying
lesion (e.g. disc defect, mass, osteophyte) inthe cervical canal or foramen.
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Valsalvas Maneuver
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Dejerines Sign
Procedure: Patient seated. Instruct them to
cough, sneeze, and bear down as if
defecating (Valsalvas maneuver).Positive Test: Local pain or pain radiating
to the shoulders or upper extremities
indicates an increase in intrathecal pressure.Structures Affected: Space-occupying
lesion.
Cervical Neurological
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Cervical Neurological
Compression and Irritation
Clinical Signs and Symptoms
Cervical pain.
Upper extremity radicular pain. Loss of upper extremity sensation.
Loss of upper extremity reflexes.
Loss of upper extremity muscle strength.
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Foraminal Compression Test
Procedure: Patient seated. Exert strong
downward pressure on the head. Repeat
with b/l rotation.Positive Test: Local pain may indicate
foraminal encroachment without nerve root
pressure or apophyseal capsulitis.Radicular pain may indicate pressure on a
nerve root.
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Foraminal Compression Test
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Jacksons Compression
Procedure: Laterally flex the head and exert
strong downward pressure. Perform b/l.
Positive Test: Local pain may indicateforaminal encroachment without nerve
pressure or apophyseal joint pathology.
Radicular pain may indicate pressure on anerve root.
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Jacksons Compression
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Spurlings Test
Procedure: Laterally flex the patients head
and gradually apply strong downward
pressure. If no pain is elicited, put thepatients head in a neutral position and
deliver a vertical blow to the uppermost
portion of the patients head.
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Spurlings Test
Positive Test: Local pain indicates facet
joint involvement. Radicular pain indicates
nerve root pressure.
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Spurlings Test
Maximum Foraminal
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Maximum Foraminal
Compression Test
Procedure: Have the patient approximate
the chin to the shoulder and extend the
head. Perform b/l.
Maximum Foraminal
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Maximum Foraminal
Compression Test
Positive Test: Pain on the side of rotation
with a radicular component may indicate
nerve compression. Local pain with noradiculopathy may indicate apophyseal joint
pathology on the side of rotation. Pain
opposite of rotation indicates muscular or
ligamentous strain.
Maximum Foraminal
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Maximum Foraminal
Compression Test
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Shoulder Depression Test
Procedure: Apply downward pressure on
the shoulder while laterally flexing the
patients head to the opposite side.
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Shoulder Depression Test
Positive Test: Local pain on the side being
tested indicates shortening of the muscles,
muscular adhesions, muscle spasm, orligamentous injury. Radicular pain may
indicate compression of the neurovascular
bundle or thoracic outlet syndrome. Pain on
the opposite side indicates a decreased
foraminal space, facet pathology, or disc
defect.
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Shoulder Depression Test
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Distraction Test
Procedure: Grasp beneath the mastoid
processes and press up on the patients
head. This removes the weight of thepatients head on the neck.
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Distraction Test
Positive Test: If local pain increases,
suspect muscle strain, spasm, ligamentous
sprain, or facet capsulitis. Relief ofradicular pain indicates either foraminal
encroachment or a disc defect.
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Distraction Test
Shoulder Abduction Test
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(Bakodys Sign)
Procedure: The patient should abduct the
arm and place the hand on top of the head.
Positive Test: A decrease or relief of thepatients symptoms indicates a cervical
extradural compression problem (i.e.
herniated disc, epidural vein compression,or nerve root compression).
Shoulder Abduction Test
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(Bakodys Sign)