Name___________________
Chapter 11 Cervical and Thoracic Spinal Conditions
Topic: Injury Evaluation and Differential Diagnosis
1. When completing an assessment, clinicians should consider appropriate questions to ask and
why, what to look for and why, and what things should be tested and why. Depending on the
answers of the patient (and the examiner should consider several different responses), several
possible causes of the patient’s problem may become evident. A differential diagnosis may
affect the treatment plan.
A 14-year-old male football athlete was involved in a spearing collision during a game that
you were covering as an athletic trainer. He complains of neck pain and is unable to move
without increasing the radiating pain. How would you differentiate between an acute cervical
disc herniation and a cervical fracture?
Acute Cervical Disc
Herniation
Onset
Mechanism
Pain
Observation/inspection
Palpation
ROM
Stress/special tests
Neurologic findings
Acute
Forced axial loading or
hyperflexion
Radiating pain into neck,
shoulder, and arm
Affected side may be limp;
unable to move
Painful over affected vertebral
level; muscle spasm may be
present
Painful and limited AROM and
PROM for all neck movements,
especially flexion, rotation, and
lateral flexion
Limited and weak RROM; may
not test this right away due to
contraindications and radiating
pain
Valsalva maneuver (positive)
Spurling’s maneuver (positive)
Should be assessed; depending on
level and severity, may have
dermatome and myotomes
decreased
Cervical Fracture
Acute
Forced axial loading or
hyperflexion
Radiating pain, numbness, in
dermatome
Unable to move without
increasing symptoms
Neck may be tilted toward
involved side
Painful over spinous processes;
palpable defect may be present
Painful and limited AROM and
PROM; unable to perform and is
contraindicated with positive
neurologic findings
Cervical compression (positive)
Should be assessed; pain and
numbness along dermatomes;
weakness or paralysis along
myotomes
Injury Evaluation & Differential Diagnosis
2
2. After completion of the history and palpation components of assessment for a neck injury
sustained by a wrestler, an injury is suspected to the sternocleidomastoid or trapezius.
Explain testing to confirm this suspicion.
Testing should include AROM and RROM for the cervical spine, including neck flexion,
extension, lateral flexion, and rotation. Normal ranges are: flexion 80–90; extension 70;
lateral flexion 20–45; rotation 70–90.
3. When and why should a scan examination be used as part of a cervical spine assessment?
Active movement should not be performed when pain is present over the vertebrae or when
motor/sensory deficits are present. If there is no pain over the vertebrae or no motor/sensory
deficits, a scan exam can be used to assess general motor function. It can potentially rule out
injury at other joints that may be overlooked because of intense pain or discomfort at the
primary injury site.
4. Provide the action that corresponds to the nerve root segment.
Nerve Root Segment
a.
C1–C2
b.
C3 and CN XI
c.
C4 and CN XI
d.
C5
e.
C6
f.
C7
g.
C8
h.
T1
Action Tested
Neck flexion
Lateral neck flexion
Shoulder elevation
Shoulder abduction
Elbow flexion and/or wrist extension
Elbow extension and/or wrist flexion
Thumb extension and/or ulnar deviation
Finger abduction and adduction