Cervical spine.pptx for disck problem and mylopathy

Spine

1. Cervical spine history and examination Prepared by / Mutawakel al- shehari Supervision/ Dr / Khaled alnuzyli Dr Essam alnagashii

2. Cervical spine *Introduction *History *Examination *Special test

3. Cervical spine Bones 33 vertebrae from vertebral column 7 cervical- atlas(1) and axis(2),small 12 thoracic- 1-10 have rib attachment 5 lumbar- larger 5 sacral- fused Coccyx- 4 fused

4. Cervical spine C2-AXIS Designed for maximum ROM C7-”Bump” at the base of neck Very Mobile Most mobile part of the spine

5. Cervical spine *Introduction *History *Examination *Special test

6. History: _Neck pain _Numbness _Stiffness _Deformity

7. Neck pain : Onset Sudden: herniated disc, infection, tummor Gradual: Stenosis, RA, spondylosis, Site : Neck, neck and arm Unilateral or bilateral Type of pain : Aching: degenerative., Stenosis Sharp : herniated disc.. Rest and night pain: metastatic bone

8. Numbness: Radiclopathy related to dermatom: C3..Neck C4 tip of shoulder C5.. lateral elbow C6.. thamb C7 .. midfinger C8.. little finger

9. Stiffness: Prolonged morning Stiffness: Rheumatoid arthritis Anklosing spondylitis Inflammatory arthropathy..etc

10. Trauma: RTA , High energy: fracture or ligamentous injury Falling not from High : Neck sprain Disc prolapse Fracture in osteoporotic pt

11. Age of patient: Children: Congenital, developmental, p.tumor, infection Adult: Disc prolapse, , fracture Old age: spondylitis, Stenosis , metastatic , osteoporosis

12. Cervical spine examination: Look(inspection) Feel(palpation) Move(passive and active)

13. Look _ scar : location, traumatic or sugical, 1ry or 2ed intention _ skin pigmentation _ alignment : stiff neck : Disc lesion (to ward lesion) Inflammatory process Acute sprain Torticolles (congenital or 2ry)

14. Feel: _ spinous process : Tenderness or deformity First one to feel is C2 Most prominent is C7 _ palpable mass : bony or spasm _ thyroid, trachea, LAP _ facet joint 2.5 cm from midline post.medial

15. Move: _ flextion : "Chein to chest" about 75 degree Limited in : Spondliosis, RA , herniated disc _ extension : Looking up about 60 Limited or painfull in : Facet joint degeneration, disc, Fixed kyphosis or s scoliosis

16. Move : _ latral flexion : "Put your ear to shoulder" About 20 to 45 degree Limited in : Radiclopathy LAP Torticollis

17. Move : Lateral rotation : "Put your chain to shoulder" About 70 - 90 degree Limited or painfull in: R.Arthitis Spondylosis Cervical spine

18. Muscle testing: *C5 nerve root: Between C4_C5 Deltoid muscle testing Abduction Arm 90_60 Down pressure by examiner

19. Muscle testing: C6 nerve root : Examination of biceps, Rest extensors,

20. Muscle testing: *C7 nerve root: Between C6_C7 _Rest flexors muscle testing _ triceps testing:

21. Sensory testing: related to dermatom: C3..Neck C4 tip of shoulder C5.. lateral elbow C6.. thamb C7 .. midfinger C8.. little finger

22. Reflexes: Biceps reflex for C5 Brachoradialis reflex for C6

23. Reflexes: Triceps reflex for C7

24. Spical test: Spurling's maneuver(foraminal compression test ) Narrowing of vertabra foramina Lead to radiclopathy Axial pressure Slightly extension

25. Spical test: Babinski test (planter flexion test ) For myelopathy Liner pressure on lateral of sole + ve if dorsal flexion occur - ve if planter flexion occur

26. Spical test: Hoffmann’s sign Specific test for cervical myelopathy . flick to index finger flexion of the thumb and index

27. Spical test:

28. Spical test: L'hermitt's sign: For cervical. Myopathy Hip and neck flexion +Ve electronical shock

29. Special test : Roos test : Test for thoracic outlet $ +ve if there is Numbness