Cervical Examination Components

what needs to be asked/assessed during history taking?

• age (assess whether acute issue, congenital, postural)

• numbness/tingling/radiating symptoms

• duration of symptoms and/or chronicity (immediate or delayed)

• headaches

• traumatic MOI/acute onset

• alleviating/exacerbating factors

• radicular pain/weakness of legs

• positional tolerance/endurance

• pain with straining (voiding/defecating/coughing/etc)

what is L’hermitte’s sign?

a neurological symptom characterized by an electric shock-like sensation that runs down the spine and into the limbs when the neck is flexed. It often indicates dysfunction in the spinal cord, particularly in conditions like multiple sclerosis.

what other sources of neck pain need to be thought about when doing the evaluation?

referral patterns from organs- diaphragm irritation can cause pain in shoulder and periscapular region, liver and stomach can refer to shoulder/region

if you suspect neurological involvement when examining the neck, what should you check?

the volar surface of the hands and supra/infraspinatus, also should perform the neuromuscular screen to help rule out serious pathology

parts of the cervical examination that should be included?

• history

• ROS

• visceral patterns of referral

• observation/inspection/posture

• neuromuscular screen

• palpation

• ROM

• strength

• muscle length

• edema

• structure specific testing

• functional tests

• gait/balance

• patient reported outcomes

• patient specific functional scales

• review of yellow flags with OSPRO

what structure specific tests are used to assess neck pain with mobility deficits?

• 1st rib mobility

• suboccipital release with manual traction

• cervical flexion with rotation

• cervical flexion with lateral rotation

• PA glide and unilateral PA glide

what structure specific tests are used for neck pain with movement coordination deficits?

• DNF endurance

• craniocervical flexion test

• sharp purser

• shear test

• alar ligament

• joint position error

what structure specific tests are done to assess neck pain with headaches?

• cervical flexion with rotation

• PA glide

• unilateral PA glide

consider looking up and down the chain though

what structure specific test is used for neck pain with radiating pain?

bakody’s sign (for upper trunk C5/C6) radiculopathy

what is the cluster for cervical radiculopathy?

• +ULTT median nerve

• + spurling’s test

• + distraction test (pos means symptoms alleviation)

• cervical ROM less than 60 degrees on the ipsilateral (affected) side

what are the other radicular tests?

ULTT radial and ULTT ulnar which are used based on complaints, locations of symptoms, reported parasthesia, etc, as well as the VBI (vertebral basilar artery insufficiency)

what are functional tests that demonstrate return to sport criteria?

• seated medicine ball throw

• Y balance upper quarter

• close-kinetic chain upper extremity stability test