Physical Examination

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The neck examination includes inspection for any neck lesions, masses, or scars as well as posture and normal cervical lordosis, characterized by a slight anterior curvature (Fig. 31-5). The neck is palpated for points of tenderness.

Figure 31-1 Typical cervical vertebra. S, Spinous process; L, lamina; A, articular facet; P, pedicle; T, transverse process; B, body. (Redrawn from MercierL. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 27)

Figure 31-3 Ligaments of the cervical spine. A, Anterior longitudinal ligament; P, posterior longitudinal ligament; N, nuchal ligament; I, interspinous ligament. (Redrawn from Mercier L. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 27)

Figure 31-1 Typical cervical vertebra. S, Spinous process; L, lamina; A, articular facet; P, pedicle; T, transverse process; B, body. (Redrawn from MercierL. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 27)

Figure 31-2 1, Axis. 2, Atlas and transverse ligament (T). 3, Articulation of the atlas and axis. (Redrawn from Mercier L. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 27)

Figure 31-3 Ligaments of the cervical spine. A, Anterior longitudinal ligament; P, posterior longitudinal ligament; N, nuchal ligament; I, interspinous ligament. (Redrawn from Mercier L. Practical Orthopedics, 5th ed. St Louis, Mosby, 2000, p 27)

dU 43

T1 2

10 11 12 L1

^ i^fiífl c III \ ^-iz 3 \ —i c III \ ^-iz 3 \ —i

Figure 31-4 Spinal cord and nerve roots in relation to the vertebrae.

(Redrawn from Brinker MR, Miller MD. Fundamentals of Orthopedics. Philadelphia, Saunders, 1999, p 242)

S1 2

Figure 31-4 Spinal cord and nerve roots in relation to the vertebrae.

(Redrawn from Brinker MR, Miller MD. Fundamentals of Orthopedics. Philadelphia, Saunders, 1999, p 242)

Line of gravity

POSTERIOR

Center of gravity

Sacrum

Coccyx

Flexible lordosis

Fixed kyphosis

ANTERIOR

Flexible lordosis

Fixed kyphosis

Neutral 0°

Neutral 0°

9GC

Neutral 0C

Neutral 0C

9GC

Neutral 0C

Neutral 0C

Figure 31-6 Range of motion. A, Flexion. B, Lateral flexion. C, Rotation.

(Redrawn from Carr AJ, Harnden A. Orthopedics in Primary Care. Newton, Mass, Butterworth-Heinemann, 1997, p 56.)

Figure 31-6 Range of motion. A, Flexion. B, Lateral flexion. C, Rotation.

(Redrawn from Carr AJ, Harnden A. Orthopedics in Primary Care. Newton, Mass, Butterworth-Heinemann, 1997, p 56.)

Table 31-1 Normal Range of Movement: Neck (Cervical Spine)

Motion

Range

Flexion

0-45 degrees

Extension

0-45 degrees

Lateral flexion

0-45 degrees

Rotation

0-60 degrees

Modified from Carr AJ, Harnden A. Orthopedics in Primary Care. Newton, Mass, Butterworth-Heinemann, 1997.

Figure 31-5 Vertebral spine. Note that thoracic spine has relatively fixed kyphosis and lumbar spine relatively flexible lordosis. (Redrawn from BrinkerMR,

MillerMD. Fundamentals of Orthopedics. Philadelphia, Saunders, 1999, p 241.)

The range of movement is assessed by observing forward flexion with chin tilted down toward the chest and backward extension with the head tilted backward so that the eyes are looking toward the ceiling (Fig. 31-6). Lateral flexion to the right and left is the lateral bending of the neck, pointing the ear toward the shoulder on the same side. Lateral rotation to the right and left is the chin turned toward each shoulder while the head is kept upright (Table 31-1).

Examination should also include examination of the extremities. Inspection of the upper limbs may reveal muscle wasting or fasciculations. A detailed examination of the nervous system includes assessment of the power and tone of the muscles, reflexes, and sensory system, using sharp and light touch. Mapping the sensory loss by dermatomes and demonstrating asymmetry of deep tendon reflexes may show the cervical level with nerve compression. A complete general

examination, including the head, neck, lower extremities, and gait, allows for evaluation of other potential causes and effects of neck problems. Specific tests to evaluate the cervical spine also include the axial compression test, which may increase symptoms of radicular pain. The distraction test may relieve radicular symptoms. Spurling's test may produce pain on the same side as nerve root encroachment.

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