Transcript Cervical Exam - Logan Class of December 2011

Cervical Exam
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Vitals
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Appearance. Mood, Orientation
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Cervical Muscle symmetry, Cervical Posture (P-A & Lat)
Palpation
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A&OX3, No Apparent Distress, Well Dev. Well Nour
Visual Inspection
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Seated BP (L & R), Respiration, Pulse, Ht, Wt, Temp
Musculature, Interspinous spaces, Thyroid, Trachea, Lymph,
EENT, other
Sensory
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UE Dermatomes, Other Sensory
 Sharp/Dull, Vib, Position sense
Cervical Exam
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Motor
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UE
 Deltoids (C5)
 Biceps (C6)
 Wrist Extension (C6)
 Triceps (C7)
 Finger Extension (C7)
 Finger Flexion (C8)
 Finger Adduction (T1)
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Reflexes
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UE
 Biceps (C5)
 Triceps (C7)
 Brachioradialis (C6)
 Hoffman’s
Cervical Exam
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Circumferential Measurements
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Arm @ 5” proximal to elbow
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Forearm @ 5” distal to elbow
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L&R
Tracheal
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L&R
Upper neck
Pharyngeal
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Lower neck
Cervical Exam ROM
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Flexion
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Extension
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60 °
Rotation
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50 °
80 °
Lat Flexion
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45 °
Cervical Exam Orthopedics
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Bakody
Dejerine’s Triad*
Distraction
Foraminal Compress
Jackson’s Compression
Max Foraminal
Compression
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* This test shows up in more than 1 Exam
Shoulder Depression
Spinal Percussion*
Spurlings
Swallowing
Valsalva*
Cervical Exam Orthopedics
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BAKODY SIGN:
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Procedure: patient seated,
actively places palm of
hand on top of head,
raising the elbow to even
with head.
(+): if relieves/ pain or
radiation.
Indicates: nerve root
compression.
Cervical Exam Orthopedics
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DEJERINE’S TRIAD*:
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Procedure: patient
seated, then cough,
sneeze, and strain.
(+): pain.
Indicates: disc
protrusion, spinal cord
tumor or spinal
compression fracture.
Cervical Exam Orthopedics
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DISTRACTION :
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Procedure: patient seated , and
the dr. distracts the patient’s
head upward.
(+): if  or  pain.
Indicates: 1. if pain – muscle
spasm.
 2. If no pain – IVF
encroachment.
Clinical note: the higher the
poundages of static cervical
traction, the more unstable the
nerve compression syndrome is.
Cervical Exam Orthopedics
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FORAMINAL COMPRESSION
TEST:
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Procedure: patient seated in neutral
position and dr. applies downward
pressure on the head. The dr. rotates
the head in 1 direction and applies
downward pressure on the head, and
repeats in the other direction.
(+): if localized or radicular pain.
Indicates: 1. if localized – IVF
encroachment. 2. if radicular – nerve
root compression.
Clinical note: with compression
maneuvers the neck may collapse or
buckle. This is found in grade II or
greater sprains.
Cervical Exam Orthopedics
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JACKSON’S COMPRESSION
TEST:
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Procedure: patient seated and
actively rotates head to right and
left. Then the dr. laterally bends
the patient’s head to each side
and applies downward pressure.
(+):  local or radicular pain.
Indicates: nerve compression
from – SOL, sublux.,
inflammation, D.J.D, tumor, or
disc herniation.
Cervical Exam Orthopedics
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MAX FORAMINAL
COMPRESSION:
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Procedure: patient seated and
actively rotates and
hyperextends the neck towards
the side of radicular complaint.
Then rotates and maximally
flexes head towards side of
complaint.
(+): reproduction of symptoms.
Indicates: IVF encroachment.
Cervical Exam Orthopedics
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SHOULDER DEPRESSION:
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Procedure: patient seated and
dr. separates the patient’s head
and shoulder on side of
complaint.
(+):  or reproduced radicular
pain.
Indicates: brachial plexus
stretch or dural adhesions
(sharp/burning pain).
Cervical Exam Orthopedics
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SPINAL PERCUSSION*:
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Procedure: patient seated
with head flexed, dr.
percusses the sp’s and
paravertebral musculature.
(+): if localized or radiating.
Indicates: 1. local – fracture
or severe sprain.
 2. radicular – IVD
syndrome.
Clinical note: ultrasound
may aggravate the
condition.
Cervical Exam Orthopedics
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SPURLING’S TEST:
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Procedure: patient seated,
dr. bops patient on head.
(+):  pain.
Indicates: nerve root
compression, spondylosis,
disc diseases.
Cervical Exam Orthopedics
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SWALLOWING:
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Procedure: patient
seated and takes a drink.
(+): if painful swallowing.
Indicates: SOL,
ligamentous sprain,
muscular strain, or
fracture, disc protrusion,
tumor, osteophyte at the
anterior portion of the
c/spine.
Cervical Exam Orthopedics
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VALSALVA*:
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Procedure: do I have to
explain???
(+): /reproduce pain.
Indicates: space
occupying lesion
(herniated disc or tumor),
or osteophyte.