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Cervical Spine Examination: Difference between revisions
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==Diagnostic Validity== | ==Diagnostic Validity== | ||
*Cervicogenic | *[[Cervicogenic Headache]] | ||
**Reduced cervical extension, impaired craniocervical flexion test, and segmental dysfunction is predictive of positive C2/3 or C3/4 block<ref>{{#pmid:32376753}}</ref> | **Reduced cervical extension, impaired craniocervical flexion test, and segmental dysfunction is predictive of positive C2/3 or C3/4 block<ref>{{#pmid:32376753}}</ref> | ||
**Impaired flexion-rotation test suggests C1-2 source. | **Impaired flexion-rotation test suggests C1-2 source. | ||
Revision as of 18:08, 24 May 2021
This article is a stub.
Sequence
Standing
Look
Sitting
- Look
- Palpation (muscles)
- Gross screening movement
- Sharp Purser
- Spurling
- Neurologic examination
- C0-C2 axial rotation test[1]
- Patient is seated with the neck in a neutral position. Stabilise the second cervical vertebra with the clinician's index finger and thumb against the articular pillar and spinous process of C2. Passively rotate the head left and right isolating movement to segmental levels above C2.
- Fixation does not allow normal motion, and normal range during fixation is 30° combined rotation to each side
- Reliability and Validity: At least moderate reliability[2]
- False Positives: This does not require endrange flexion of the lower cervical spine and so can be used to assess C0-C2 rotation mobility in the presence of lower cervical spine pain and dysfunction.
Supine
- Palpation of articular pillars and paraspinal musculature
- Segmental movement, quality of movement, end feel.
- Translatory movement
- Flexion rotation test (FRT)[3][1]
- Lie the patient supine with the cervical spine and thoracic spine in complete flexion. Assess range of motion with rotation to the left and right.
- This passive test assesses movement dysfunction at the C1/2 segment. The C1/2 segment comprises around 60% of the total cervical range of motion regardless of age. By maximally flexing the neck, theoretically all structures below C2 are constrained and therefore have limited ability to contribute to rotation. Range of motion reduces with age by about 4-7° per decade. Normal values are 44° to each side.
- Reliability and Validity: It has been shown to be accurate and reliable.
- False Positives: Painful joints in the lower cervical spine may give a false positive as this reduces the normal range to 37.5°.
- Craniocervical flexion test (CCFT)
- Lie the patient in supine crook lying position with the head in neutral position, the line of the face should be horizontal (use towels if necessary)
- Place the deflated biofeedback unit behind the neck so it abuts the occiput, inflate to 20mmHg
- Patient slowly performs cranio-cervical flexion, until they reach a pressure increase of 2mmHg, hold for 10 seconds, then return to the starting position. If the patient has an apical breathing pattern, the nod is performed in exhalation.
- Repeat this for each 2mmHg increment, until 30mmHg is reached (5 stage)
- The stage the patient is able to achieve and hold for 10 seconds with correct cranio-cervical flexion is the baseline measure
Side Lying
- Articulation/Segmental mobility
Diagnostic Validity
- Cervicogenic Headache
- Reduced cervical extension, impaired craniocervical flexion test, and segmental dysfunction is predictive of positive C2/3 or C3/4 block[4]
- Impaired flexion-rotation test suggests C1-2 source.
References
- ↑ 1.0 1.1 Satpute et al.. The C0-C2 axial rotation test: normal values, intra- and inter-rater reliability and correlation with the flexion rotation test in normal subjects. The Journal of manual & manipulative therapy 2019. 27:92-98. PMID: 30935342. DOI. Full Text.
- ↑ Satpute et al.. The C0-C2 axial rotation test - Reliability and correlation with the flexion rotation test in people with cervicogenic headache and migraine. Musculoskeletal science & practice 2021. 51:102286. PMID: 33187891. DOI.
- ↑ Schäfer, Axel Georg Meender, et al. “Upper Cervical Range of Rotation during the Flexion-Rotation Test Is Age Dependent: An Observational Study.” Therapeutic Advances in Musculoskeletal Disease, Jan. 2020, Full Text
- ↑ Getsoian et al.. Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks. BMJ open 2020. 10:e035245. PMID: 32376753. DOI. Full Text.
