The Cervical Spine. 방배경희한의원 M.D., O.M.D. 신정봉. The Cervical Spine - History -. In general, a good history-taking provides information about: The patient ’ s age Symptoms Pain Paraesthesia vertigo Drugs. The Cervical Spine - History -. 1. Age Acute torticollis
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In general, a good history-taking provides information about:
We look for :
A. bilat. arm ele.
Shoulder girdle exam
C. Active bilateral arm elevation
D. Nerve root examination
Bilateral : all resisted tests on the good side first.
1. Motor conduction
2. Sensory conduction
The Cervical Spine- CLINICAL EXAMINATION -
1. Motor conduction(Thumb, Little finger)
B. Shoulder shrugging
2. Sensory conduction
A sensory deficit is sought in the distal part of the dermatomes
Biceps Jerk C5,C6
Brachiradialis J C5
Triceps J C7
Tests for neurogenic integrity and alternative causes of arm pain
Pain/limitation → Shoulder examination?
(tests for motor conduction):
Thumb extension – C8
Little finger adduction – T1
Not tally with the clinical findings:
B. Disc protrusion
-> pain & tenderness
②C1- or C2- palsy
③motor deficit C4 (shoulder shrug)
④sensory deficit C5
1. Acute torticollis
2. Unilateral cervicoscapular aching
3. Unilateral root pain
5.Bilateral scapular aching
C. other disorders /
1.Differential diagnostic interpretation
“ All discs are alike, but all other disorders are different.”
1. Neck movements
2. Shoulder shrugging
3. Arm tests
4. Neuralgic amyotrophy
no sever pain
usually Cs weakness
5. pressure on a nerve root
2. post-concussion headache
①Our first problem is to find out whether the headache is organic or alleged.
②The immobility, imposed by the concussion, can also lead to upper cervical ligamentous adhesions, which should be ruptured by manipulation.
③A muscular lesion, at its occipital insertion, is treated by deep friction.
3. The facet joints
Moreover, a disc protrusion is more probable than a facet joint lesion if ;
①the pain is felt on the midline
②there is a shifting pain
③the attacks of unilateral aching are not always felt on the same side
④if a cough hurts
Dr. Troisier describes two clinical patterns in case of a facet joint lesion:
e.g. left sided pain on extension, rotation and side flexion to the left
e.g. left sided pain on flexion, rotation and side flexion to the right.
Headache of cervical origin can either be segmental or extrasegmental.
8. Thoracic pain
9. Misleading tenderness
11. Acute torticollis children
12. Acute torticollis in adult and adolescents
13. Spasmodic torticollis
14. Spastic torticollis
15. Hysterical torticollis
16. Inspection of the scapular area
① position of the scapula
② isolated wasting of the infraspinatus muscle