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Cervical Spine Exam

Introduction

Greetings
Hand wash
Verify the patient's identity using at least two or three details
Explanation
Consent
Ask for dominant hand

The shoulder is usually slightly lower on the side of handedness

Look

Skin abnormalities
Posture of cervical spine and scapular region
Asymmetry/wasting in the neck or scapular region and arm/hand bilaterally
Cervical posture / chin protrusion / upper cervical lordosis

Poor cervical posture with chin protrusion and increased upper cervical lordosis is common

Palpations

Temperature / Warmth

Use back of hands and compare sides

Cervical spinous processes

Key landmarks: external occipital protuberance, C2 (1st bony spinous process below occiput), C5-6 apophyseal joint, C7 spinous process

Soft tissue contours

Include upper trapezius muscle bulk

Movement

Active
Rotation

Normal = 45 degrees to each side

Cervical flexion

Upper: chin to neck, Lower: chin to chest

Cervical extension

Upper: chin protrusion with extension, Lower: looking to ceiling

Lateral extension

Tilt head sideways, ear to shoulder

Apley's scratch test

Used to assess simple shoulder movements

Passive

If active ROM is reduced, try to establish whether pain or a true limitation in range is underlying this

Cervical rotation
Cervical flexion
Cervical extension
Lateral flexion

Special tests

Spurling / Cervical quadrant test

Patient rotates head to side, examiner passively extends neck. Pain on same side suggests facet joint impingement

Brachial plexus stretch test

Elevate and externally rotate straight arm, then laterally flex head to opposite side and extend wrist

Mention that you will perform a complete neurological assessment of the upper limb and assess the peripheral pulses of the upper limb as well.

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