Cervical examination and special tests.pptx

Objective:
To equip 3rd year Bachelor of Physiotherapy (BPT) students with the knowledge and skills necessary for performing cervical special tests and conducting a comprehensive cervical examination.

1. SPECIAL TESTS CERVICAL SPINE Dr. Amrita Sakharwade Assistant Professor (Musculoskeletal Department) Datta Meghe College of Physiotherapy

2. CONTENTS Introduction Anatomy Pathologies Red flags and Yellow flags History Special tests

3. INTRODUCTION Most superior portion of vertebral column between cranium & thoracic vertebrae. Consists of 7 distinct vertebrae 2 are unique: C1   atlas C2  axis 

4. Ligaments of cervical spine

5. Joints of cervical spine Atlanto -occipital joint Atlanto -axial joint Zygopopheseal joint

6. Functions Cervical Spine Protect the brain stem & spinal cord Support the skull Allow for wide range of head movement

7. PATHOLOGIES Cervical spondylosis :  cartilage and vertebrae wear out abnormally Cervical herniated disc:  discs between vertebrae rupture, protrude, or bulge out Degenerative disc disease:  discs between vertebrae break down Cervical spinal stenosis :  spinal canal narrows around spinal cord Cervical myelopathy :  spinal cord damage caused by stenosis or degeneration Cervical radiculopathy : pinched nerve or compression

8. Interview and examine the patient before any diagnostics are performed!

9. History & Physical Exam

10. Physical Examination Inspection Palpation Range of Motion (ROM) Sensation Circulation Muscle Testing Special Tests

11. Inspection skin: rashes, abrasions, scars, color, swelling Posture, alignment, curves: kyphosis ; lordosis ; scoliosis Palpation skin: temperature, swelling, tenderness Paraspinal muscles: tenderness, spasm spinous processes: tenderness, step off muscle strength: 0 - 5

12. Reflexes Biceps (C5,C6) Triceps (C6,C7) Brachioradialis (C5,C6) *Graded 0 – 4+ ( 2+ = Normal/Average) * Use reinforcement or distraction if reflexes absent or diminished; i.e., clench teeth Range of Motion (ROM) Flexion Extension Lateral flexion Rotation

13. SPECIAL TESTS

14. FORAMINAL COMPRESSION TEST Patient position  sitting Procedure examiner turns patient's head to affected side while extending and applying downward pressure to the top of the patient's head

15. Test positive  if pain radiates into arm towards which head is side flexed during compression indicates pressure on nerve root/ intervertebral foramen Indications: Spinal nerve root involvement Herniated disc Bulging disc Foraminal stenosis

16. DISTRACTION TEST Patient position  sitting Procedure Therapist places one hand under patient’s chin and other around occiput Then slowly lifts patients head / traction to cervical spine Test positive  if pain decreases or Alleviates symptoms indicates pressure on nerve root is relieved

17. SHOULDER DEPRESSION TEST Used to evaluate brachial plexus lesion Patient position  sitting Procedure Side flex patient’s head on unaffected side Then apply a downward pressure on opposite shoulder (affected side) Test positive  if there is reproduction or exacerbation of radicular symptoms indicating nerve root compression or brachial plexus involvement If pain is localized  involvement of neck musculature or cervical facet joint is considered

18. VERTEBRAL ARTERY TEST Patient position  supine Procedure move the patients head out and neck into extension and sideflexion . Rotate patient’s head to the same side and hold for 30 secs Test positive  Dizziness & Nystagmus Significance  compression of vertebral arteries

19. DIZZINESS TEST most common symptoms associated with neck pain pseudo-vertiginous symptoms (vertigo, dizziness, unsteadiness, light-headedness, imbalance) Patient position  sitting Procedure Examiner grasps patient head actively rotates patients head to right and left hold for 10-30secs Patient’s head returned to neutral Secondly, patients shoulders are actively rotated right and left

20. Test positive  Patient experiences dizziness in both cases Signifies involvement of vertebral artery Because VA is kinked If only when head is rotated – semicircular canals

21. THANK YOU..!