Assessment of the cervical spine

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Assessment of the cervical spine
2
Overview

• Applied anatomy
• Patient history
• Observations
• Examination
• Palpation
• Special tests

3
Applied Anatomy

• Skeletal anatomy
• C1-C7
• Normal convex anterior curvature
• Significant mobilityreduced stability

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Applied Anatomy

• Skeletal anatomy
• C1-C7
• C1 Atlas
• No body, no spinous process no lamina
• Occipital condyles articulate with skull
• C2 Axis
• Odontoid process (dens)
• First palpable spinous process

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Applied Anatomy

• Spinous processes (C2-C6 bifurcated)
• Transverse processes
• Transverse foramen
• Articulations
• Atlanto-occipital joint (C0-C1)
• Atlanto-axial joint (C1-C2)

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Applied Anatomy

• Articulations
• 14 facet (apophsyeal) joints
• Situated to facilitate flexion and extension
• Greatest ROM at C5-C6, but C4-C5 C7-C7 nearly
  as great
• Most likely sites for degeneration

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Applied Anatomy

• Intervertebral discs
• Similar structure, but smaller size due to
  decreased load compared to lumbar spine
• Spinal cord
• Higher level trauma results in loss of function
  for all levels below

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Applied Anatomy

• Nerves
• Eight cervical nerve roots
• Each named for the vertebra below it in the
  cervical spine
• First between occiput and C1
• Vascular structures
• Vertebral arteries
• May be injured or kinked in end-rangerotation
  (gt45-50 deg)

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Patient History

• MOI
• How did the injury occur?
• Did the head strike anything?
• Did you hear or feel anything at time of injury?
• Back involvement?
• Did you lose consciousness?      

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Patient History

• Pain/symptoms
• How did the symptoms begin?
• Where is the pain?
• Is it sharp or dull?
• Localized or diffuse?
• Constant or intermittent?
• Aggravated by movement?

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Patient History

• Pain/symptoms (cont.)
• Relieved by rest?
• Sensations Radiating pain, Burning, or
  Numbness?
• Paralysis or paresthesia?
• Did symptoms occur right away or later?
• Any problems sleeping?
• Do you have headaches? Describe location and
  intensity of headaches.
• Is the pain affected by laughing, sneezing, or
  coughing?  

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Patient History

• Previous history
• Previous injury?
• Treatment?
• Diagnosis?
• Fully recovered?

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Observations

• Deformities
• Movement position
• Signs of trauma
• Skin color
• Skin temperature
• Abnormalities

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Observations

• Alignment of neck and back
• Iliac crest
• Leg length
• Scoliosis
• Winged scapula
• Sprengels deformity

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Observations

• Forward head
• Torticollis / Wryneck
• Lordosis
• Kyphosis

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Observations

• Compare
• Symmetry
• Shoulder height
• Muscle spasm