Cervical Spine Examination

This article is a stub.

Sequence

Standing

Look

Sitting

Look
Palpation (muscles)
Gross screening movement
Sharp Purser
Spurling
Neurologic examination

Supine

Palpation of articular pillars and paraspinal musculature
Segmental movement, quality of movement, end feel.
Translatory movement
- Flexion rotation test (FRT)^[1]^[2]
  - 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°.
- C0-C2 axial rotation test^[2]
  - 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: No studies
  - 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.

Side Lying

Articulation/Segmental mobility

Reliability and Validity

Muscle Tenderness

Kappa scores for tenderness in neck-shoulder region.^[3]
Site of Tenderness	No or occasional symptoms	Disturbing symptoms
Right Trapezius	0.62	0.22
Left Trapezius	0.6	0.15
Right Levator Scapulae	0.54	0.52
Left Levator Scapulae	0.24	0.42

Facet Joint Tenderness

References

↑ 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
↑ ^2.0 ^2.1 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.
↑ Levoska et al.. Repeatability of measurement of tenderness in the neck-shoulder region by a dolorimeter and manual palpation. The Clinical journal of pain 1993. 9:229-35. PMID: 8118085. DOI.

[1] 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

[satputea-2] 2.0 ^2.1 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.

[3] Levoska et al.. Repeatability of measurement of tenderness in the neck-shoulder region by a dolorimeter and manual palpation. The Clinical journal of pain 1993. 9:229-35. PMID: 8118085. DOI.

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