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Neck Exam
Aka: Neck Exam, Neck Exam in Cervical Disc Disease, Cervical Disc Provocative Test, Shoulder Abduction Relief Sign, Upper limb Tension Test, Cervical Radicular Pain Localization- See Also
- Signs: General
- Range of Motion
- Neck flexion and extension (45 degrees in each direction)
- Neck lateral bending to right and left (45 degrees in each direction)
- Neck rotation to right and left (80 degrees in each direction)
- Neck hyperextension elicits cervical disc related pain
- Localized C-Spine tenderness in Cervical Disc Disease
- Range of Motion
- Signs: Cervical Disc Provocative Tests
- Vertex Compression Test (Spurling Test)
- See Spurling Test
- Bend neck to ipsilateral side (lateral flexion and neck extension) with axial load
- Pressure against top of head reproduces arm pain (by compressing neural foramina)
- High Test Sensitivity and Specificity
- Shah (2004) Br J Neurosurg 18(5): 480-3 [PubMed]
- Shoulder Abduction Relief Sign
- Patient places their palm of the affected arm on top of their head
- Considered a positive test if this positioning relieves radicular pain
- Tandeter (1997) Canadian Family Physician 43:511-2
- Upper limb Tension Test
- Patient supine with neutral Shoulder at side with flexed elbow and wrist
- Examiner places counter pressure at anterior Shoulder and abducts the Shoulder to 90 degrees
- Examiner extends the elbow, wrist and fingers and supinates the Forearm
- Patient lateral deviates the neck to either side
- Considered a positive test if positioning provokes the pain
- Nee (2012) J Orthop Sports Phys Ther 42(5):413-24
- Vertex Compression Test (Spurling Test)
- Signs: Cervical Myelopathy
- See Spinal Cord Syndrome
- See Central Cord Syndrome
- See Transverse Myelitis
- See Amyotrophic Lateral Sclerosis
- Lhermitte Sign
- Passive neck flexion results in electrical sensation down spine or arms
- Hoffman Sign
- Flick the distal tip of the third or fourth finger
- Results in thumb abduction and flexion at the distal phalanx
- Upper Motor Neuron Deficits suggestive of Myelopathy
- Positive Babinski Reflex
- Hyperreflexia
- Clonus
- Clasp-knife spasticity
- Muscle Weakness
- Ataxia or other Abnormal Gait
- Bowel or Bladder dysfunction
- Tremor
- Signs: Motor Exam and Sensory Exam Localization of Radicular Pain
- Background
- See Motor Exam
- See Sensory Exam
- See Neuroanatomy of the Arm
- Diminished Deep Tendon Reflex is most common objective neurologic finding
- Loss of Triceps Reflex is most common
- Motor weakness may also be identified
- C3-4 Disc (C4 nerve root): : Accounts for <10% of Cervical Radiculopathy cases
- Pain at lower neck or trapezius muscle
- Sensory change only (no motor or reflex changes)
- Cape distribution
- Includes lower neck and upper Shoulder girdle
- C4-5 Disc (C5 nerve root): : Accounts for 10% of Cervical Radiculopathy cases
- Pain
- Base of neck
- Shoulder
- Anterolateral arm
- Numbness
- Deltoid
- Motor weakness and atrophy
- Deltoid muscle
- Biceps muscle
- Reflexes decreased
- Pain
- C5-6 Disc (C6 nerve root): : Accounts for 20-25% of Cervical Radiculopathy cases
- Pain
- Sensory change
- Dorsolateral thumb
- Index finger
- Motor weakness and atrophy
- Biceps muscle
- Extensor pollicis longus
- Reflexes decreased
- C6-7 Disc (C7 nerve root): Accounts for 45-60% of Cervical Radiculopathy cases
- Pain same as C5-6 Disc (C6 nerve root)
- Sensory change
- Index finger
- Middle finger
- Dorsal hand
- Motor weakness and atrophy
- Triceps muscle
- Reflexes decreased
- C7-8 Disc (C8 nerve root): : Accounts for 10% of Cervical Radiculopathy cases
- Background
- Signs: Referred Pain and Non-Musculoskeletal Cause Evaluation
- Lymphadenopathy (infection, malignancy)
- Upper Motor Neuron Deficit
- See Myelopathy Findings as above
- Central Nervous System Exam
- Carotid Dissection
- Vertebral Dissection
- Thoracic Dissection
- Cardiopulmonary Exam including pulses
- Abdominal Exam
- Right upper quadrant tenderness (Biliary Colic)
- Skin Exam
- References