Cervical spine

  The cervical spine can be difficult to see, particularly in women. It is important to get the hair up out of the way, but patients should not use their own arms to do this. A theatre nurse’s cap may be helpful. Just as the key to examination of the lumbar spine is a neurological examination of the lower limb, the key to the examination of the cervical spine is a neurological examination of the upper limbs.

Look

Skin

Look for scars and sinuses, particularly around the cervical lymph node area and over the thyroid. Surgical approach to the neck can be made from the front, the side or the back.

Soft tissue

Look for spasm of the trapezius muscles and the sternomastoid muscles.

Bone

The cervical spine normally has a lordosis like the lumbar spine. If this is lost there is probably muscle spasm caused by pain.

Feel

Skin

Test for sensory loss in hands and feet.

Soft tissue

Feel for spasm in the trapezius muscles.

Bone

Palpate down the contour of the cervical spine feeling for gaps or for tender areas.

Move

Active

Flexion/extension. The patient should be asked to bend their neck forward and put their chin on their chest. Look to see whether the cervical lordosis is lost. They should then extend their neck by looking up at the ceiling. Note the angle that the face makes with the ceiling as a measure of extension.

Lateral rotation. Ask the patient to look over their shoulder on each side keeping their shoulders still. Note the angle that the chin makes with the shoulders on each side.

Lateral deviation. Ask the patient to lay one ear on that shoulder, then the opposite ear on the other shoulder. Note how close they can bring each ear to its shoulder without shrugging the shoulder upwards. Note whether any of these manoeuvres are painful in extreme.

Neurological testing

The neurology of both upper and lower limbs should be tested. Lesions in the lower limbs are likely to be upper motor neuron; those in the upper limb are likely to be lower motor neuron. For testing motor power in the upper limb it is probably only necessary to test grip and the power to spread the fingers apart. Grip tests power of the finger flexors as well as the wrist extensors, so covering most of the middle cervical nerve roots. Abduction of the fingers is supplied by the lower cervical roots including Ti, so testing these two manoeuvres covers most of the motor roots from the cervical spine apart from the uppermost ones.

Passive and stability

These do not contribute much to diagnosis of problems in the cervical spine.