Cervical
spine
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.