Cervical SpineOve Indergaard MSc MCSP HPC

Anatomy

Spinal Movement

Anatomy

Anatomy

Anatomy

Objective Examination• Observation: posture, compensatory

postures, atrophy/spasm

• Movement: Active and Passive, Quality, Range and production of symptoms

• Neurological Assessment: Myotomes, Dermatomes, Reflexes, AND tests

• Special Tests: Spurlings, Brachial plexus, Thoracic outlet

• Neurological assessment: relexes, SLR, PKB, myotomes, dematomes, plantar reflexes

Posture

Posture

Movement Testing

• Cervical Spine:

• Flexion

• Extension

• Rotations

• Sideflexions

• Supine tests

• Thoracic Spine

• Shoulders

Neurological Testing

Dermatomes

Special Tests

• Spurlings test / Foraminal Compression Test

PositivePositive Pain in UE toward side laterally flexedPain in UE toward side laterally flexed postive test 95% sensitive to nerv root postive test 95% sensitive to nerv root

pathologypathology IndicationsIndications

Pressure on nerve rootPressure on nerve root ConsiderationsConsiderations

+ vertebral artery test+ vertebral artery test Osteoarthritis, osteoporosis, spinal Osteoarthritis, osteoporosis, spinal

stenosis or cervical spine instabilitystenosis or cervical spine instability

Foraminal Distraction

PositivePositive Existing complaints disappear or Existing complaints disappear or

decreasedecrease IndicationsIndications

Nerve root impingement during normal Nerve root impingement during normal postureposture

Increase in pain may indicate muscle or Increase in pain may indicate muscle or ligament injuryligament injury

Special Tests

•Brachial plexus

PositivePositive Radiating pain on side tilting Radiating pain on side tilting awayaway

from = from = brachial plexusbrachial plexus Radiating pain on side tilting Radiating pain on side tilting

towardstowards = = nerve root impingementnerve root impingement ConsiderationsConsiderations

fracturefracture

Special Tests•Thoracic Outlet:

Allen’s TestAllen’s TestPositivePositiveDiminished radial pulseDiminished radial pulseIndicationsIndicationsThoracic Outlet SyndromeThoracic Outlet Syndrome

Adson’s TestAdson’s TestPositivePositiveReduced or altered radial pulseReduced or altered radial pulseIndicationsIndicationsThoracic Outlet SyndromeThoracic Outlet Syndrome

Thoracic Outlet Cont

PositivePositive Inability to maintain test Inability to maintain test

positionposition Diminished hand functionDiminished hand function Loss of sensation in UELoss of sensation in UE

IndicationsIndications Thoracic Outlet Thoracic Outlet

SyndromeSyndrome

Management of Acute Neck Injuries (whiplash)

Whiplash cont

Management of Chronic Neck Pain

Intervention & Treatment Recommendations evidence based guidelines (JOSPT 2008)

Cervical Manipulation/Mobilisations alongside coordination, strengthening, & endurance exercises (Grade: A)

Patient Education and Reassurance are important throughout treatment. (Grade: A)

The use of upper quarter and nerve mobilisation procedures can be useful in the treatment of patients with neck pain. (Grade: B)These interventions have been shown beneficial and are even more effective when paired with manual therapy and exercise.

Use of Thoracic Mobilisation/Manipulation (Grade: A)The use of thrust manipulations and mobilisations have been shown more recently (2012) that it can reduce symptoms in patients with neck and neck related arm pain.

Use of Stretching (Grade: C) Stretching involved musculature can be beneficial for patients with neck pain.

Activity Limitations (Grade: F)The patient should be limited to functional activity that does not cause an increase in symptoms throughout the treatment period. This helps the clinician to assess changes in the patients level of function during an episode of care.

Common exercises

• Acute: ROM exercises

• Chronic: Dysfunction specific, can be stretches, motor control, stabilisations, general strength