OnExam
- Cervical Spine Assessment
Inspection
- Inspect patient in standing and sitting, anteriorly, posteriorly and laterally
- Gait
- Posture
- Muscle atrophy, hypertrophy, spasm or increased tone (eg. torticollis), trigger points
- Cervical spine posture and normal lordotic curve (observe for neutral positioning or forward head posture
- Thoracic spine and shoulders for potential causes of cervical spine dysfunction
- Assess for ankylosing spondylitis: Occiput to Wall Distance Test
- Assess for MS, cervical nerve impingement, and B12 deficiency: Lhermitte’s Sign
- Assess for impingement of cervical root and radicular pain
Palpation
- Note areas of pain, swelling, spasm, atrophy, deformity or crepitus in:
- Each cervical spinous process
- Facet joints deep in trapezius muscle from C2-C7
- Paraspinal muscles
- Trapezius muscle
- Sternocleidomastoid muscles
- Thoracic spine
- Shoulders including scapula
Percussion
- Percuss each vertebra from C1-C7 with the hypothenar aspect of a closed fist to suggest (or detect possible) malignancy, degenerative disease or osteomyelitis
- Malignancy
- Post-test probability if positive: 86%
- Specificity for malignancy: 60%
- Osteomyelitis
- Post-test probability if positive: 10.0% (LR+ = 2.1)
- Post-test probability if negative: 1.2% (LR- = 0.2)
Range of Motion
- Forward flexion (normal = 45°), “Chin to chest”
- Extension (normal = 50°), “Look up at ceiling”
- Lateral flexion (normal = 45°), “Ear to shoulder”
- Rotation (normal = 70°), “Turn head from side to side”
References
- Baxter S, ed., McScheffrey G, ed. Toronto Notes: Comprehensive Medical Reference & Review for MCCQE 1 & USMLE 2. 26th ed. Toronto: Toronto Notes for Medical Students Inc; 2010.
- Bickley L. Bate’s Guide to Physical Examination and History Taking. 10th ed. New York: Lippincott Williams & Wilkins; 2009.
- Filate W, Leung R, Ng D, Sinyor M, eds. Essentials of Clinical Examination Handbook. 5th ed. Toronto, ON. University of Toronto, 2005.
- Hurley K. OSCE and Clinical Skills Handbook. Halifax: Elsevier Canada; 2005.
- Pawa J, Lesniak, D., & Lott, A. Approach to the OSCE: The Edmonton Manual of Common Clinical Scenarios. Edmonton Manual; 2011.