Cervical Spine Evaluation
I.
HISTORY
1. Chief Complaint
______
B.
2.
3.
4.
5.
6.
7.
8.
______
______
______
______
______
______
______
History of the Present Problem
When did you first notice the symptoms
Have you had any history of this problem or related problems
Anyone in your family has similar symptoms
What activity were you engaged in at the onset of symptoms
Was there any change in activity recently
Any specific mechanism (cause) you were aware of
Did you hear or feel anything at the time of onset
C. Time Sequence
9. Was the onset of symptoms sudden or gradual
10. How long did the symptoms last
11. Have the symptoms been constant or intermittent
12. When do the symptoms typically occur
______
______
______
______
D. Location of Symptoms
13. Point with one finger to the location of the symptoms
14. Is there more than one area of symptoms
______
______
E. Symptom Characteristics
15. Characterize the pain (dull/sharp/throbbing/burning/etc)
16. Does the pain radiate and, if so, where
17. What increases the pain
18. What relieves the pain
19. How do symptoms affect your activity level
______
______
______
______
______
F. Participation Characteristics
20. What Sport/Activity do you play
21. What Position or Event
22. What are the frequency, intensity and duration of practice
23. Could equipment be related to your symptoms
24. What type of playing environment
25. What type of warm-up pattern do you use
______
______
______
______
______
______
G. Personal Management
26. Have you attempted any treatment
27. Have you taken any medication
28. Have you seen anyone else for this problem (who and what)
29. Do you have any opinion of your own about the problem
30. Is there anything else you would like me to know
______
______
______
______
______
II.
III.
IV.
OBSERVATION/INSPECTION.
31. Make the area visually available
32. Bilateral Observation
33. Deformity
34. Bleeding
35. Scars
36. Discoloration
37. Swelling
38. Cervical Curvature
39. (Explain)
40. Position of the Head
41. (Explain)
42. Soft Tissue Comparison
43. Level of the Shoulders
44. (Explain)
______
______
______
______
______
______
______
______
______
______
______
______
______
______
PALPATION
42. Hyoid Bone
43. Thyroid Cartilage
44. Cricoid Cartilage
45. Sternocleidomastoid
46. Scalenes
47. Carotid Artery
48. Lymph Nodes
49. Occiput
50. Superior Nuchal Lines
51. Transverse Process
52. Spinous Process – C___
53. Spinous Process – C7
54. Trapezius
55. Erb’s Point
______
______
______
______
______
______
______
______
______
______
______
______
______
______
RANGE OF MOTION
56. Active Cervical Flexion
57. (G)
58. WNL
59. Active Cervical Extension
60. (G)
61. WNL
62. Active Cervical Right Lateral Flexion
63. (G)
64. WNL
65. Active Cervical Left Lateral Flexion
66. (G)
67. WNL
68. Active Cervical Right Lateral Rotation
______
______
______
______
______
______
______
______
______
______
______
______
______
IV.
69. (G)
70. WNL
71. Active Cervical Left Lateral Rotation
72. (G)
73. WNL
______
______
______
______
______
74. Passive Cervical Flexion
75. Passive Cervical Extension
76. Passive Cervical Right Lateral Flexion
77. Passive Cervical Left Lateral Flexion
78. Passive Cervical Right Lateral Rotation
79. Passive Cervical Left Lateral Rotation
______
______
______
______
______
______
80. Resisted Cervical Flexion
81. Resisted Cervical Extension
82. Resisted Cervical Right Lateral Flexion
83. Resisted Cervical Left Lateral Flexion
84. Resisted Cervical Right Lateral Rotation
85. Resisted Cervical Left Lateral Rotation
______
______
______
______
______
______
STABILITY TESTS
Cervical Compression Test
86. Positioning
87. Contraindication(s)
88. Evaluative Procedure
89. Positive Test Result
90. Implication
______
______
______
______
______
Spurling Manuever
91. Positioning
92. Evaluative Procedure (to Right)
93. Evaluative Procedure (to Left)
94. Explain different findings: Nerve Root and Brachial Plexus
95. Positive Test Result
96. Implication
______
______
______
______
______
______
Foraminal Distraction Test
97. Positioning of Patient
98. Hand Placement
99. Evaluative Procedure
100.
Positive Test Result
101.
Implication (specific)
______
______
______
______
______
V.
VI.
Brachial Plexus Traction Test
102.
Positioning
103.
Evaluative Procedure
104.
Positive Test Result
105.
Implication - 1
106.
Implication – 2
______
______
______
______
______
SPECIAL TESTS
Valsalva Maneuver
107.
Positioning (Considerations)
108.
Evaluative Procedure
109.
Positive Test Result
110.
Implication
111.
Do not perform with: __________
______
______
______
______
______
Shoulder Abduction Test
112.
Positioning
113.
Evaluative Procedure
114.
Positive Test Result
115.
Implication
______
______
______
______
Oppenheim Test
116.
Position
117.
Evaluative Procedure
118.
Positive Test Result
119.
Implication
______
______
______
______
NEUROVASCULAR ASSESSMENT
Adson Maneuver
120.
Positioning
121.
Evaluative Procedure
122.
Positive Test Result
123.
Implication
______
______
______
______
Allen Test
124.
125.
126.
127.
Positioning
Evaluative Procedure
Positive Test Result
Implication
______
______
______
______
Roos Test
128.
Positioning
129.
Evaluative Procedure
130.
Positive Test Result
______
______
______
131.
132.
133.
VII.
Positive Test Result – 2
Positive Test Result – 3
Implication
______
______
______
Vertebral Artery Test
134.
Positioning (SUPINE)
135.
Evaluative Procedure
136.
Positive Test Result
137.
Implication
______
______
______
______
Babinski Test
138.
Positioning
139.
Evaluative Procedure
140.
Positive Test Result
141.
Implication
______
______
______
______
NEUROVASCULAR
142.
143.
144.
Presence of Parathesia
Noted Muscle Weakness
Noted Loss of Motion
______
______
______
Dermatome’s
145.
C5
146.
C6
147.
C7
148.
C8
149.
T1
150.
T2
151.
Dermatome Assessment
______
______
______
______
______
______
______
Myotome’s
152.
C4
153.
C5
154.
C6
155.
C7
156.
C8
157.
T1
______
______
______
______
______
______
Deep Tendon Reflex’s
158.
C5
159.
C6
160.
C7
______
______
______