Cervical Spine Pathologies
and Special Tests
Orthopedic Assessment III – Head,
Spine, and Trunk with Lab
PET 5609C
Pathologies

Brachial Plexus Pathology:

Brachial Plexus Neuropraxia:
 Common
name: “Burner” or “Stinger”
 Definition:
“Transient brachial plexopathy involving the
upper trunk”
 “Temporary episode of unilateral upper extremity
burning dysethesia with or without motor
weakness”


“Stinger” → tingling that occurs in upper
extremity after injury
Pathologies

Brachial Plexus Pathology:
 Epidemiology: (specific
studies)
50% of a Division I FB team
had 1 or more burners/season
(Robertson et al.)
 65% of DIII FB players (201)
during careers / 57% > 1
burner (Sallis et al.)



70% reported additional
burners that they did NOT
report
↑ occurrence with defensive
players (DB’s)
Pathologies

Brachial Plexus:
C5 – T1


7 cervical
vertebrae
8 cervical nerves:
 1st
7: exit above
the corresponding
vertebrae
 C8: exits below
the 7th cervical
vertebrae
Pathologies

Brachial Plexus Pathology:

Mechanism of Injury:

Stretch of the brachial plexus:



Nerve root compression:




Head forced laterally while opposite shoulder is depressed
(common MOI – tackling)
C5 and C6 (most commonly affected)
Combination of neck hyperextension and ipsilateral lateral
flexion
Nerve roots impinged between vertebrae
Spinal stenosis - ↑ risk
Compression of brachial plexus:

Direct blow to Erb’s point (shoulder pads compress plexus)
Pathologies
(A) Traction to the brachial plexus (ipsilateral shoulder depression and
contralateral lateral neck flexion) (B) Direct blow to the supraclavicular fossa
(Erb's point) (C) Compression of the cervical roots or brachial plexus (ipsilateral
lateral flexion and hyperextension)
Pathologies
Pathologies

Brachial Plexus Pathology:

Signs and symptoms:





Numbness and burning of the entire arm, hands, fingers
Sensation loss over dermatomes
Complete transient paralysis of affected nerves
Tenderness over the brachial plexus
Grading:



Grade 1 (Neuropraxia): transient signs/sx. last from a few
minutes → 2 weeks
Grade 2 (Axonotmesis): significant sensory/motor deficits > 2
weeks and less than < 6 months
Grade 3 (Neurotmesis): symptoms 6 months → 1 year
Pathologies

Brachial Plexus Pathology: Evaluation

Inspection:
Athlete shakes arm/hand in attempt to regain feeling
 Inspect cervical spine for abnormality
(fracture/dislocation)


Palpation:
Cervical spine
 Clavicle, humerus, scapula, sternum, ribs
 SC, AC, GH joints
 Shoulder musculature

Pathologies

Brachial Plexus Pathology: Evaluation

Functional Testing:


Active and passive ROM (all neck and shoulder movements)
RROM – can be performed in conjunction with myotome
check


Neurological Screening:


Key muscles tested: deltoid, external rotators, biceps brachii
Upper quarter sensory/motor testing
Special Tests:



Brachial plexus stretch test
Cervical compression and distraction
Spurling test
Clinical Evaluation
C1-C2
Neck flexion
C3
Neck lateral flexion
C4
Shoulder shrug
C5
Shoulder abduction, ER
C6
Elbow flexion, wrist extension
C7
Elbow extension, wrist flexion
C8
Thumb extension
T1
Finger abduction and adduction
Pathologies

Brachial Plexus Pathology:

Return to Play Criteria:
 Full,
pain-free active and passive ROM in the
cervical spine
 Full, pain-free neck strength against resistance
 Full strength of all shoulder and arm movements
 Normal sensation in all dermatomes
 Check shoulder pads/helmet to ensure proper fit
 Recheck in 3-5 minutes
Protective Equipment:
A: Neck Roll
B: Lifter
C: Cowboy Collar
Pathologies

Research Article #1:

Effects of Football
Collars on Cervical
Hyperextension and
Lateral Flexion


Objective: Evaluate the
effectiveness of 3 football
collars in ↓ cervical ROM
Why:


MOI for stingers
Do the collars ↓
movement?
 PREVENTION
Pathologies

Effects of FB Collars on Cervical
Hyperextension and Lateral Flexion:
 Methods:
 Subjects:
15 D1 football players
 Force applied (hand-held dynamometer)
 Motion: 2-dimensional video analysis
 Movement:

AROM and PROM
 Hyperextension
 Lateral flexion
Hyperextension Findings:
Lateral Flexion Findings:
Can be limited by all 3 collars: (rankings)
No collar ↓ passive lateral flexion better
1. Cowboy collar 2. A-Force 3. Neck roll
than the shoulder pads alone
Note: Passive overloading still resulted in
additional 190 of hyperextension
Standard neck roll ↓ active ROM
Pathologies

Research Article #2:

Biomechanical Analysis of Football Neck Collars:

Objective: Perform a biomechanical analysis of neck collars
through dynamic testing

Why:


MOI for head and neck injuries
Do the collars ↓ force transmission (upon impact)?
Pathologies

Biomechanical Analysis of FB Neck Collars:

Methods:

Collars (3) evaluated:




Crash-test dummy:



Cowboy collar (McDavid)
Bullock collar
Kerr collar
Shoulder pads (raised and unraised), helmet, collar
Accelerometers / load cells / angular rate sensors
Impacts:

Pneumatic linear impactor
 5 m/s and 7 m/s
Pathologies

Biomechanical Analysis of FB Neck Collars:

Results:

Top of Head Impact:


Front Impact:



Most protection: Kerr collar (Bullock – 2nd)
 Why? Kerr collar contacts the base of the helmet
during impact → redirects some load to shoulders
Most protection: Kerr collar (all provided ↑ protection)
↓ head and neck movement **
Side Impact:


Kerr – minimal protection
Cowboy and Bullock – no protection
Peak Values for Front Impact: Normal Shoulder Pad Configuration
Pathologies

Cervical Nerve Root
Impingement:

History:




Onset: Acute of chronic
Pain: Radiating symptoms
into trapezius, scapula,
shoulder, arm, wrist, and hand
MOI: Compression or
irritation of nerve
Predisposing conditions:

Disc pathology, narrowing
of intervertebral foramina,
facet degeneration
Pathologies

Cervical Nerve Root Impingement:

Inspection:


Palpation:


Posture of head
Point tenderness
Functional Tests:

Pain with extension, lateral bending toward same side, and rotation


Neurological Tests:

Upper quarter screen:


AROM, PROM, RROM
Muscle weakness, paresthesia, diminished reflexes
Special Tests:



Cervical compression test (↑ symptoms)
Cervical distraction test (↓ symptoms)
Spurling test / Vertebral artery test / Abduction test
Special Tests

Brachial Plexus Traction Test:

Patient position:


ATC position:


Standing behind the patient
Procedure:



Seated
One hand placed on side of the patient’s head; other hand over
the AC joint (same side)
Cervical spine is laterally bent and opposite shoulder depressed
Positive test:

Radiating pain on the side opposite the lateral bending


Stretching of brachial plexus
Radiating pain on the side toward the lateral bending

Compression of cervical nerve roots between 2 vertebrae
MOI is duplicated in attempt to replicate the athlete’s symptoms. Radiating
pain down left shoulder – traction injury / Radiating pain down right
shoulder – compression injury. Perform bilaterally and do NOT perform with
suspected cervical spine fracture and/or dislocation.
Special Tests:

Cervical Compression Test:

Patient position:


ATC position:


Standing behind the athlete with hands interlocked over the top
of the patient’s head
Procedure:


Sitting
Press down on the crown of patient’s head
Positive test:


Pain in upper cervical spine and/or upper extremity
Implication;

Compression of the facet joints and narrowing of the intervertebral
foramen
Special Tests
Cervical Compression
Test: Attempts to
duplicate patient’s
symptoms by ↑ pressure
on cervical nerve roots.
Do NOT perform test
until cervical fracture,
dislocation, or instability
has been ruled out.
Special Tests

Spurling Test (Foraminal Compression):

Patient position:


ATC position:


Standing behind the athlete with hands interlocked over crown
of patient’s head
Procedure:


Seated
Patient laterally flexes the head while a compressive force is
placed along patient’s cervical spine
Positive test:


Radiating pain down patient’s arm
Implication:

Nerve root impingement
Special Tests
Spurling’s Test:
Attempts to compress
a cervical nerve root.
Do NOT perform until
a cervical fracture,
dislocation, or
instability has been
ruled out.
Special Tests

Cervical Distraction Test:

Patient position:


ATC position:


At head of patient with one hand under the occiput and the
other on top of the forehead (stabilizing head)
Procedure:


Supine (relaxes the muscles acting on the cervical spine)
Apply traction on patient’s head, causing distraction of cervical
spine
Positive test:


Relief or reduction in symptoms
Implications:

Compression of the cervical facet joints and/or stenosis of neural
foramina
Cervical Distraction Test: Attempts to relieve patient’s symptoms
by ↓ pressure on cervical nerve roots. Do NOT perform test until
cervical fracture, dislocation, or instability has been ruled out.
Special Tests

Vertebral Artery Test:

Patient position:


ATC position:


Seated at head of the patient with hands placed under the
occiput to stabilize the head
Procedure:



Supine
Passively extend and laterally flex the cervical spine (1)
Head is rotated toward the laterally flexed side and held for 30
seconds (2)
Positive test:


Dizziness, confusion, nystagmus, unilateral pupil changes,
nausea
Implication:

Occlusion of the cervical vertebral arteries
Vertebral Artery Test: Used to
assure the competency of the
vertebral artery prior to
initiating treatment or
rehabilitation techniques that
may compromise a partially
occluded artery. Do NOT
perform until the presence of a
cervical fracture, dislocation, or
instability has been ruled out.
Positive Test: Refer to
physician