Cervical Examination

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Subjective

Patient Intake

• Self‐report
• Performance‐based outcome measures
• Region‐specific historical examination

Special Questions

• Red Flags
• Yellow Flags
  

Investigations

• Radiological Considerations
  

Objective

Observation

• Posture
• o Observe the patient’s posture in standing and sitting. As a part of the examination, postural deviations can be corrected to determine the effect on the patient’s signs and symptoms.
  o Common postural deviations:
  • Protracted cervical spine or forward head posture
  • Protracted shoulder girdle and rounded shoulders
  • Upper Thoracic Spine
  • Kyphotic or Flexed
  • Lordotic or Extended
  • Normal
  • Middle Thoracic Spine
  • Kyphotic or Flexed
  • Lordotic or Extended
  • Normal
  
  
• Movement Patterns

Functional Tests

1. Cervical AROM (1)
a. Prior to movement testing the examiner asks the patient about baseline symptom location and intensity. The examiner notes any change in location or intensity during the testing and where in the motion they occur.
b. The examiner should assess for the presence of symptom centralization and peripheralization during testing. Repeated motions may be utilized as part of this assessment.
c. Neck flexion, extension, rotation and side-bending can be measured with an inclinometer
d. All cervical AROM tests performed with the patient in seated in an upright posture
e. Inclinometer cervical ROM measurements have exhibited reliability coefficients ranging from 0.66 to 0.84 (ICC).
f. A universal goniometer is used to measure cervical rotation if measured in sitting.
g. Passive overpressure may be applied at the end of active motion to assess for pain response and end-feel.
h. Combined motions:
• Upper cervical flexion and lower cervical extension is assessed with cervical retraction.
• Upper cervical extension with lower cervical extension is assessed with cervical protraction.
• The cervical quadrant involves combined cervical extension with ipsilateral rotation and sidebending.
2. Cervical and Thoracic Segmental Mobility(1)
a. The patient is positioned in prone. Cervical and thoracic spine segmental mobility and pain response are assessed.
b. The examiner contacts each cervical spinous process with the thumbs. The examiner applies an oscillatory posterior to anterior force.
c. The examiner can assess mobility unilaterally by performing the same procedure over the cervical articular pillar on each side.
d. The examiner assesses for pain provocation at each segment.
e. The mobility of the segments is judged to be normal, hypermobile, or hypomobile. Interpretation of mobility is based on the clinician’s perception and experience.
f. Psychometric data for combined pain provocation and mobility assessment:
• Sensitivity = 0.82 (negative Likelihood Ratio = 0.23)
• Specificity = 0.79 (positive Likelihood Ratio = 3.9)
g. Pain ICC = 0.42 – 0.79 (For patients who have cervical neck pain)
h. Presence of upper cervical Joint dysfunction in patients with headaches ICC = 0.78 – 1.0.
3. Passive OA Joint testing(flexion/extension)
a. Patient positioned in supine with head on or off the treatment table
b. Therapist is in standing at the head of the patient
c. Motion testing (Right OA joint)
• Rotate head 20 – 30 to right side to orient the right facet into the sagittal plane
• Translate occiput anteriorly on the superior facet of C1 to asses for OA extension restriction
• Translate the occiput posteriorly to assess for OA flexion restriction.
• Repeat to the Left side.
4. AA Mobility Testing (Cervical Rotation in Flexion)
a. Cradle head with both hands
b. Contact the posterior aspect of C1 with finger tips
c. Flex cervical spine
d. Assess amount of rotation to each side
e. Maintain flexion while rotating

Palpation

• supine
• prone
• seated

Movement Testing

• AROM, PROM, and Overpressure
• Passive Intervertebral Motion
• Muscle Strength
  

References

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