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?
- Nausea / Vomiting?
- 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?
- 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
- History of problems in that area before
- How was it managed?
- Assessment undertaken?
- 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
- Flexion / Extension
- Lateral Flexion
- 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)
- Biceps Jerk (C5/6)
- Triceps Jerk (C7/8)
- Brachioradialis Jerk (C6/7)
- *Coordination (if seems more like a SYSTEMIC neurological problem rather than a SPINAL one)
- Upper Limb Tension Test
- Cervical bones
- Anyone you think needs imaging should be discussed with senior medical staff
- NEXUS Criteria
- Canadian C-Spine
- Red flags
- CT / MRI (need to discuss with specialty registrar)
- Significant neurological dysfunction
- Gross motor changes
- Urinary retention / incontinence