Cervical and thoracic spinal assessment

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If significant physical finding indicates possible nerve involvement, immobilization and immediate transportation to the nearest medical facility are warranted, regardless of whether a total assessment is complete.
Range of Motion Tests

—Assessment potentially includes active ROM, passive ROM, and resisted ROM

—Bilateral comparison should be performed

  • Cervical flexion 80–90

  • Cervical extension 70

  • Lateral cervical flexion (left and right) 20–45

  • Cervical rotation (left and right) 70–90

Manual Muscle Tests

  • Muscle Grading

Normal = 5 Full strength

Good = 4 Slight weakness

Fair = 3 Noticeable weakness; + pain

Poor = 2 Gravity only; – pain

Trace = 1 Without gravity

Zero = 0 No contraction

  • Muscles

Anterior neck flexors

Anterolateral neck flexors

Posterolateral neck extensors

Upper trapezius

Stress and Functional Tests

  • Brachial plexus traction test

  • Cervical compression test

  • Spurling test

  • Cervical distraction test

  • Shoulder abduction test

  • Vertebral artery test

  • First thoracic nerve root stretch

Neurologic Tests

  • Babinski test

  • Oppenheim test

  • Hoffman’s sign

  • Dermatomes (normal, hyperesthesia, hypoesthesia, anesthesia, superficial tactile sensation, superficial pain sensation)

    • C2 – occipital protuberance

    • C3 – supraclavicular fossa

    • C4 – acromioclavicular joint

    • C5 – lateral upper arm

    • C6 – lateral forearm, thumb, 1st finger

    • C7 – middle finger

    • C8 – 4th and 5th fingers, medial forearm

    • T1 – medial upper arm

  • Myotomes

    • C1-C2 – neck flexion

    • C3 – lateral neck flexion

    • C4 – shoulder elevation

    • C5 – shoulder abduction

    • C6 – biceps flexion, wrist extension

    • C7 – triceps extension, wrist flexion

    • C8 – finger flexion

    • T1 – finger abduction

  • Reflexes

    • Biceps (C5, C6)

    • Brachioradialis (C5, C6)

    • Triceps (C7, C8)


  • Carotid pulse

  • Radial pulse

  • Capillary refill

Activity-Specific Functional Tests

  • Performance of active movements typical of the movements executed by the individual during sport or activity participation

  • Should assess strength, agility, flexibility, joint stability, endurance, coordination, balance, and activity-specific skill performance

Quick Reference – Tests

Stress and Functional Tests

  • Brachial plexus traction test

    • Examiner side flexes patient’s (pt) head to one side while applying a downward pressure on the contralateral shoulder

    • If test is +, increased pain, radiating through upper arm =

      • Radiating to opposite side of lateral bending: tension of brachial plexus

      • Radiating to same side as lateral bending: compression of cervical nerve root between vertebrae

  • Cervical compression test

    • Pt is seated

    • Examiner standing behind pt with hands interlocking on top of pt’s head; presses down

    • If test is +, pain in upper cervical spine, upper extremity, or both = possible facet joint, narrowing of intervertebral foramen, or disc

    • Do not perform until r/o cervical fracture or instability!

  • Spurling test

    • Examiner interlocks hands over top of pt’s head

    • Pt extends and laterally flexes cervical spine

    • Examiner applies compressive force through cervical spine

    • If test is +, radiating pain down arm = nerve root impingement (narrowing neural foramina)

  • Cervical distraction test

    • Pt is supine and relaxed

    • Examiner: one hand under occiput; other hand on top of forehead to stabilize head

    • Examiner applies traction to head (distract cervical spine)

    • If test is +, relieve/decrease symptoms = compression of facet joint/stenosis

  • Shoulder abduction test

    • Pt is seated or standing

    • Pt is instructed to actively abduct arm so hand is resting on top of head

    • If test is +, decreased tension on involved nerve root = herniated disc or nerve root compression

  • Vertebral artery test

    • Pt is supine, head off table

    • Examiner: support pt’s head with hands under occiput

    • Examiner extends and laterally flexes cervical spine

    • Examiner rotates head toward laterally flexed side and holds for 30 seconds (keep eyes open)

    • If test is +, dizziness, confusion, nystagmus, unilateral pupil change, nausea = occlusion of cervical vertebral arteries

  • First thoracic nerve root stretch

    • Pt positioned with the forearm pronated to 90°

    • Pt instructed to abduct the arm to 90° and flex the elbow (should be no symptoms elicited in this position)

    • Next, pt must place their hand behind the head, fully flexing the elbow (action stretches the ulnar nerve and T1 nerve root)

    • If test is +, pain in the scapular area or arm = T1 nerve root pathology

Neurologic Tests

  • Babinski

    • Pt is supine with the eyes closed and the leg held in a slightly elevated and flexed position

    • Examiner: pointed object is stroked along the plantar aspect of the foot

    • Normal sign is for the toes to curl downward in flexion and adduction

    • If test is +, extension of the big toe and abduction (splaying) of the other toes = upper motor neuron lesion

  • Oppenheim

    • Pt is supine

    • Examiner runs a fingernail along the crest of the anteromedial tibia

    • If test is +, the great toe extends and the other toes splay or hypersensitivity to the test =

upper motor neuron lesion

  • Hoffman’s sign

    • Examiner holds patient’s middle finger and briskly flicks the distal phalanx

    • If test is +, the interphalangeal joint of the thumb of the same hand flexes = upper motor neuron lesion

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