Cervical Spine Examination

Introduction0/6

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent
• Ask for dominant handThe shoulder is usually slightly lower on the side of handedness

Look0/4

• Skin abnormalities
• Posture of cervical spine and scapular region
• Asymmetry/wasting in the neck or scapular region and arm/hand bilaterally
• Cervical posture / chin protrusion / upper cervical lordosisPoor cervical posture with chin protrusion and increased upper cervical lordosis is common

Palpations0/3

• Temperature / WarmthUse back of hands and compare sides
• Cervical spinous processesKey landmarks: external occipital protuberance, C2 (1st bony spinous process below occiput), C5-6 apophyseal joint, C7 spinous process
• Soft tissue contoursInclude upper trapezius muscle bulk

Movement0/11

• Active
  • RotationNormal = 45 degrees to each side
  • Cervical flexionUpper: chin to neck, Lower: chin to chest
  • Cervical extensionUpper: chin protrusion with extension, Lower: looking to ceiling
  • Lateral extensionTilt head sideways, ear to shoulder
  • Apley's scratch testUsed to assess simple shoulder movements
• PassiveIf active ROM is reduced, try to establish whether pain or a true limitation in range is underlying this
  • Cervical rotation
  • Cervical flexion
  • Cervical extension
  • Lateral flexion

Special tests0/2

• Spurling / Cervical quadrant testPatient rotates head to side, examiner passively extends neck. Pain on same side suggests facet joint impingement
• Brachial plexus stretch testElevate and externally rotate straight arm, then laterally flex head to opposite side and extend wrist

• Mention that you will perform a complete neurological assessment of the upper limb and assess the peripheral pulses of the upper limb as well.