Cervical Spine Evaluation

survey the scene

• primary survey

• ABCs

• level of concsiousness

history (10)

• witness

• MOI

• previous history

• type of pain

• paralysis

• parasthesia

• headache

• nausea, dizziness, faintness

• what increases/decreases the pain

• change in intrathecal pressure (laugh, cough, sneeze)

observation (10)

• obvious deformity

• signs of trauma

• swelling

• discoloration

• gait

• overall posture alignment

• splinting of the neck

• willingness to move

• muscle atrophy

• facial expression

bony palpations (10)

• hyoid bone

• thyroid cartilage

• first cricoid ring

• carotid tubercle

• supraclavicular fossa

• first three ribs

• mastoid processes

• occipital protuberance

• superior nuchal line

• cervical vertebrae (C7, work superiorly)

soft tissue palpations (7)

• greater occipital nerves

• lymph nodes

• thyroid gland

• parotid gland

• carotid pulse

• sternocleidomastoid

• trapezius

muscle test, sensory, and reflex of C1-C2

• neck flexion

• none

• none

muscle test, sensory, and reflex of C3

• lateral neck flexion

• none

• none

muscle test, sensory, and reflex of C4

• shoulder elevation

• supraclavicular

• none

muscle test, sensory, and reflex of C5

• abduction of arm

• lateral arm

• biceps

muscle test, sensory, and reflex of C6

• elbow flexion, wrist extension

• lateral forearm

• brachioradialis

muscle test, sensory, and reflex of C7

• elbow extension, wrist flexion, finger extension

• middle finger (dorsum)

• triceps

muscle test, sensory, and reflex of C8

• finger flexion, thumb extension, ulnar deviation

• medial forearm, ring and little finger

• none

muscle test, sensory, and reflex of T1

• finger ab/adduction

• medial arm

• none

special tests for nerve root compression (4)

• cervical distraction

• Spurling (cervical compression)

• Naffziger

• shoulder abduction test

special tests for brachial plexus injury (2)

• shoulder depression

• tinel’s sign @ Erb’s point

other special tests (4)

• vertebral artery test - occlusion of vertebral artery on opposite of neck flexion

• sharp-purser test - instability of C1-C2 articulation

• valsalva - space-occupying lesion, stenosis, could be disc

• swallowing - ensuring CN IX is intact