clin skills cervical spine

atlanto-occipital joint

15-20 degrees flex/ext

atlantoaxial joint

10-15 degrees flex/ext

half of rotation ROM is at

atlantoaxial C1-C2 with remainder at C2-C7

lateral flexion primarily at

C2-C7

capsular pattern of restriction

full flexion in presence of limited extension and a symmetrical limitation in rotation and lateral flexion

cervical instability from hx

trauma (whiplash, sports, falls, diving accidents)

prolonged corticosteroid use (fibroblast shutdown)

osteoporosis

down syndrome, ehlers danlos

pediatric patients under 12

alar ligament test

Palate C2 spinous process, passively rotate or SB the skull, C2 should immediately move; if not, then possibility of ruptured alar ligament

transverse ligament test aka

sharp-purser test

patient seated, palpate C2 SP with one hand and place other hand on pts forehead. pt slightly flexes neck. If C1 is subluxed you will feel the head slide backward when you apply pressure

if stability tests are positive

put pt in a cervical collar if available and immediately refer to doc or ER

educate!!!

vertebral artery test

pt supine with head off table, passively move pts head to cervical extension, lateral flexion, and rotation. hold for 30s while pt counts backward from 30 aloud to monitor slurring of speech

what should you watch for in vertebral artery test

nystagmus (rapid eye movement)

dizziness

c/o visual/sensory changes

slurring of speech

if vertebral artery test is positive

refer to doc or ER

cervical flexion

axis - centered over external auditory meatus

stationary arm - either perpendicular and subtract 90 or parallel to ground

moving arm - base of the nares (nose)

stabilization for c flex

shoulder girdle or sternum to prevent forward flexion of thoracic spine

testing motion for c flex PROM

one hand on back of head, other on chin. push head anterior while pulling chin toward chest. end ROM where you feel resistance to further movement

testing motion for c flex AROM

instruct pt to "tuck your chin to your chest and bend head forward while keeping trunk straight"

normal c flex ROM

45 degrees

tissue stretch end feel

bubble inclinometer c flex

if using two, subtract T1 reading from head

cervical extension

axis - centered over auditory meatus

stationary arm - either perpendicular and subtract 90 or parallel to ground

moving arm - base of nares (nose)

stabilization for c ext

shoulder girdle and chest to prevent extension of thoracic/lumbar spine

testing motion PROM

one hand on back of head, other on chin, push upward and posteriorly on chin while using other hand to support head

testing motion AROM

start neutral, ask pt to look up and back as far as possible without moving trunk

normal c ext ROM

45 degrees

tissue stretch end feel

bubble inclinometer c ext

lateral to T1, subtract from head

cervical lateral flexion

axis - over SP of C7

stationary arm - over SP of thoracic vertebrae so arm is perpendicular to ground

moving arm - over dorsal midline of head (occip protub)

stabilization for c lat flex

shoulder girdle opposite side of direction of motion to prevent lateral flexion of thoracic/lumbar spine

testing motion c lat flex PROM

one hand on top of pt's head, other stabilize, move toward ipsilateral shoulder, do not allow rot, flex, ext

testing motion c lat flex AROM

ask pt to try to touch ear to ipsilateral shoulder without moving head forward, rot, or ext, keep trunk straight and relaxed

normal c lat flex ROM

45 degrees

tissue stretch end feel

cervical rotation

axis - over center of top of head

stationary arm - parallel to an imaginary line between the L & R acromial processes

moving arm - aligned with tip of nose

stabilization for c rot

contralateral shoulder girdle and chest to prevent thoracic/lumbar rot

testing motion for c rot PROM

hold pt's chin and rotate head

testing motion for c rot AROM

ask pt to rotate head by turning chin toward shoulder without moving shoulder girdle or trunk

normal c rot ROM

60 degrees to each side

tissue stretch end feel

90 minus reading on dial

functional cervical flexion

bending forward to tie shoes, picking up an object from floor, washing axilla, donning pants in standing

functional cervical extension

drinking from a glass, sit to stand, returning to upright after picking up from floor, reaching high shelf

functional cervical lateral flexion

washing axilla, brushing teeth, donning a jacket

functional cervical rotation

backing up a car, looking L and R to cross the street, showering, donning a jacket, brushing teeth

muscles responsible for cervical flexion

longus capitits, longus colli, rectus capitis anterior, anterior scalene, sternocleidomastoid

MMT cervical flexion gravity resisted pos

grade 5-4, supine, shoulders 90 deg abd, elbows flexed 90 deg, dorsal forearms resting on table

MMT cervical flexion stabilization

via pts abdominal muscles via fixating action on thorax; if abs are weak, examiner manually stabilize over anterior aspect of thorax

MMT cervical flexion palpation

SCM

MMT cervical flexion examiner action

PROM first to assess availability of motion, tuck chin to chest and flex c-spine thru full ROM

patient AROM first

then resistance

MMT cervical flexion resistance

forehead toward neck extension

cervical flexion grading 3-0

3 full ROM against gravity without fair resistance with sub SCM

2 partial ROM

1 palpable contraction

0 no contraction

muscle responsible for anterolateral neck flexion

SCM

MMT anterolateral neck flexion gravity resisted

supine, head turned to contralateral side, shoulders 90 abd, elbows flexed 90 deg, dorsal forearms resting on table

MMT anterolateral neck flexion gradual resistance

over lateral aspect of skull toward exam table

muscles responsible for neck extension

obliquus capitis superior, rectus capitis posterior major, rectus capitis posterior minor, spinalis cervicis, splenius cervicis, semispinalis capitis and spinalis capitis, longissimus capitius, illiocostalis cervicis, longissimus cervicis, semispinalis cervicis, splenius capitis, upper trap

MMT neck extension gravity resisted

prone with head in neutral, shoulders abd to 90, elbows flexed, ventral forearms resting on table

MMT neck extension stabilization

upper thorax

MMT neck extension gradual resistance

occiput toward neck flexion