Cervical Spine
Ove 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
Positive



Pain in UE toward side laterally flexed
postive test 95% sensitive to nerv root
pathology
Indications


Pressure on nerve root
Considerations



+ vertebral artery test
Osteoarthritis, osteoporosis, spinal
stenosis or cervical spine instability
Foraminal Distraction

Positive


Existing complaints disappear or
decrease
Indications


Nerve root impingement during normal
posture
Increase in pain may indicate muscle or
ligament injury
Special Tests
• Brachial plexus

Positive



Radiating pain on side tilting away
from = brachial plexus
Radiating pain on side tilting
towards = nerve root impingement
Considerations

fracture
Special Tests
• Thoracic Outlet:
Allen’s Test
Positive

Diminished radial pulse
Indications


Thoracic Outlet Syndrome
Adson’s Test
Positive

Reduced or altered radial pulse
Indications


Thoracic Outlet Syndrome
Thoracic Outlet Cont

Positive




Inability to maintain test
position
Diminished hand function
Loss of sensation in UE
Indications

Thoracic Outlet
Syndrome
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