Cervical Spine Examination

Cervical Spine Examination

 
  • If a mechanism or pattern:
    • When did it happen?
    • What happened exactly?  Try to understand the mechanism and forces involved (if present)
    • What symptoms initially?
      • Where were the symptoms initially?
      • Describe pain – sharp / superficial / deep / ache / burning etc
      • What aggravates and what eases?
      • Headaches?
      • Nausea / Vomiting?
      • Dizziness?
      • Pins and needles or numbness anywhere, particularly in the upper limb?
      • Loss of appetite or loss of weight?
      • Weakness or incoordination
        • Upper Limbs
        • Lower Limbs (need to do Lumbar Ax as well if this is the case).
    • What symptoms now?
      • Have the symptoms changed? Better / Worse? Location?
  • If no mechanism
    • How long has it been there?
    • Is there anything that they believe may have contributed to the development of the problem? Recent activity / inactivity
    • What symptoms are present?
    • Are they there all the time?
  • What treatment has been sought so far?
    • Assessment
    • Investigations
      • If imaging, do they have it with them?
      • If not, can we view it?
        • Private providers use online applications
        • If in another public hospital in Victoria, then can use the “Synapse Mix” service to get the images temporarily put on local network diagnostic imaging servers.
  • What management has been undertaken? Has it been effective
    • Splinting
    • Ice
    • Medications
  • History of problems in that area before
    • When?
    • How was it managed?
      • Assessment undertaken?
      • Investigations
      • Medications
    • Any ongoing problems?
  • Any associated symptoms (if a non mechanical cause or if at all suspicious)
    • Recent illness / fevers / sweats
    • Recent overseas / long haul travel / immobilisation (eg for suspected DVT)
    • Loss of appetite / loss of weight, etc
  • If has a wound
    • Tetanus status
  • If potentially needing procedural sedation or surgery (and consider this for anyone you are contemplating an x-ray for)
    • Fasting status (and tell them not to eat and drink until you tell them it is ok to do so
 
Goals in ED
  • Rule out fracture / dislocation
  • Rule out significant neurological dysfunction
  • Rule out non-musculoskeletal cause
AROM
  • Flexion / Extension
  • Rotation
  • Lateral Flexion
Neurological Examination
  • Power
    • Shoulder girdle elevation (C4)
    • Shoulder elevation (C5)
    • Elbow flexion (C5/6)
    • Elbow extension (C7/8)
    • Wrist flexion / extension (C6/7)
    • Finger flexion / extension (C7/8)
    • Finger abduction / adduction (T1)
  • Reflexes
    • Biceps Jerk (C5/6)
    • Triceps Jerk (C7/8)
    • Brachioradialis Jerk (C6/7)
  • Sensation
    • Dermatomal
  • *Coordination (if seems more like a SYSTEMIC neurological problem rather than a SPINAL one)
    • FTN
    • *Dysdiadokokinesia
Neuromeningeal Testing
  • Upper Limb Tension Test
 
Palpation
  • Cervical bones
  • Muscles
Imaging
  • Anyone you think needs imaging should be discussed with senior medical staff
  • X-ray
    • NEXUS Criteria
    • Canadian C-Spine
    • Red flags
  • CT / MRI (need to discuss with specialty registrar)
    • Significant neurological dysfunction
    • Gross motor changes
    • Urinary retention / incontinence