Cervical spine

Objective assessment –

Posture (asymmetry, dead tilt, kyphosis), palapation for tenderness or increased tone, AROM, PROM, strength testing

Brachial plexus

is a complex network of nerves that originates in the neck and extends down into the shoulder, arm, and hand.

It's formed by the anterior rami (roots) of the spinal nerves C5, C6, C7, C8, and T1.

brachial plexus is responsible for both motor and sensory innervation of the entire upper limb, with the exception of the trapezius muscle

CAD red flag

Cervical Arterial Dysfunction (CAD).

CAD is not a specific diagnosis itself but rather a broad category encompassing various conditions like arterial dissection, embolism, or stenosis.

dysfunctions can potentially lead to cervico-cranial ischemia

5 Ds, 3 Ns

Dizziness Dysphagia (difficulty swallowing) Dysarthria (difficulty speaking) Diplopia (double vision) Drop attacks.

Nystagmus (involuntary eye movements) Numbness (facial or unilateral body) Nausea

VBI

Vertebrobasilar Insufficiency.

VBI is a condition where there is a temporary reduction of blood flow to the posterior part of the brain, supplied by the vertebral and basilar arteries.

Certain movements or positions of the neck can sometimes compress or irritate these arteries, leading to reduced blood flow

VBI Test

To screen for vertebrobasilar insufficiency (VBI) before certain manual therapy techniques. Involves sustained end-range rotation and extension, observing for dizziness, nystagmus  

Upper Limb Tension Tests (ULTTs) / Neural Tension Tests

To assess the mechanosensitivity of the median, radial, and ulnar nerves

Nerve root dysfunction

radiculopathy, occurs when a spinal nerve root becomes compressed, irritated, or damaged as it exits the spinal column. Causes; herniated disc, stenosis, bone spurs, trauma

Special tests: Spurling's

to assess for cervical nerve root compression. The neck is extended, laterally flexed towards the symptomatic side

Special tests: distraction test

To relieve pressure on neural structures. Axial traction is applied to the head. A positive test is a decrease in radicular symptoms.

Red flags

night pain, Unexplained weight loss, Fever, Signs of spinal cord compression

Dermatomes

Sensory Testing: Assess light touch, pinprick, and temperature sensation in dermatomal pattern. Key dermatomes to assess include C4-T1

Myotomes

– motor testing.

C4: Shoulder shrug (Trapezius)

C5: Shoulder abduction (Deltoid, Biceps)

C6: Elbow flexion (Biceps), Wrist extension (Extensor carpi radialis longus and brevis)

C7: Elbow extension (Triceps), Wrist flexion (Flexor carpi radialis and ulnaris), Finger extension (Extensor digitorum)

C8: Finger flexion (Flexor digitorum profundus and superficialis), Thumb abduction (Abductor pollicis longus and brevis)

T1: Finger abduction (Abductor digiti minimi), Finger adduction (Adductor digiti minimi)

Reflexes

Assess deep tendon reflexes (DTRs) of the upper limbs:

C5: Biceps brachii reflex

C6: Brachioradialis reflex

C7: Triceps brachii reflex

Upper Motor Neuron Testing (if myelopathy suspected)

Hoffmann's sign: Flicking the middle finger and observing for flexion of the thumb and index finger.

Babinski sign: Stroking the lateral sole of the foot and observing for dorsiflexion of the big toe and fanning of the other toes.

Clonus: Rhythmic involuntary muscle contractions, often at the ankle.

NAGS

Natural Apophyseal Glides. oscillatory mobilizations applied to the facet joints (apophyseal joints) of the cervical and upper thoracic spine (typically C2-T3). The therapist applies a gentle, repetitive gliding force in an antero-cranial (forward and upward) direction 

SNAGS

Sustained Natural Apophyseal Glides. involve a sustained glide of a specific facet joint while the patient performs the symptomatic movement.

The therapist identifies the painful or restricted movement and then applies a continuous, corrective accessory glide

Cervical spondylosis (OA)

age-related condition. "wear and tear". discs between the vertebrae can dehydrate and shrink. Neck pain/stiffness 

Cervical Disc Herniation

soft, gel-like center (nucleus pulposus) of an intervertebral disc in your neck (cervical spine) bulges or ruptures. Radiating Arm Pain (Radiculopathy): This is a hallmark symptom 

Cervical Radiculopathy

Pinched Nerve. occurs when one of the nerve roots exiting the cervical spine (neck) becomes compressed or irritated

Cervical Spinal Stenosis

narrowing of the spinal canal in the neck (cervical spine). This narrowing can put pressure on the spinal cord and the nerves

Cervical Strain

pulled neck muscle, is an injury to the muscles and tendons in your neck. These soft tissues can be overstretched or torn due to sudden movements, sustained awkward postures, or overuse

Whiplash

Whiplash is a neck injury caused by a sudden, forceful back-and-forth movement of the neck, much like the cracking of a whip 

• Grade 0: No complaints or physical signs of injury. 

• Grade 1: Neck pain, stiffness, or tenderness, but no other physical signs. 

• Grade 2: Neck pain and musculoskeletal signs like decreased range of motion or point tenderness. 

• Grade 3: Neck pain and neurological signs, including reduced deep tendon reflexes, muscle weakness, or sensory deficits. 

• Grade 4: Neck pain with evidence of fracture or dislocation. 

Cervical Myelopathy

results from compression of the spinal cord in the neck (cervical spine). This compression can damage the spinal cord and lead to a variety of neurological symptoms

PROMS: PSFS

Patient-Specific Functional Scale.

Patients are asked to identify 3 to 5 activities that they are having difficulty performing or are unable to do as a result of their cervical spine condition.

These activities should be relevant and important to the individual's daily life and functional goals.

Rated 0-10 on ability to perform

PROMS: neck disability index

To quantify the impact of neck pain on a person's ability to manage everyday life activities.The NDI is a 10-item questionnaire. Each item focuses on a different aspect of daily life that can be affected by neck pain out of 50  

Exercise prescription

ROM exercises. Chin tucks and rotations (neck flexor), strength exercises (shoulder blade squeezes and hold), wall slides for posture correction

NICE guidelines

emphasize the importance of staying active and avoiding prolonged rest.

For myelopathy urgent referral for adults with rapidly progressive symmetrical numbness and weakness.

For whiplash, gradually returning to normal activities.