cerivcal spine speacial testPresented by MD.NIJAM UDDIN

SHAIKH

THE CERVICAL SPINE ANATOMY

THE CERVICAL SPINE ANATOMY: The spinal column is a series of motion segments each of which consist of an inter- body joint and it's two adjacent zygapophyseal joints formed between the posterior arches of the vertebra above and below.

The cervical spine is designed for mobility. The cervical spine is most mobile spine . It's wide range of verity of movement are relegated to change in the direction of vision the positioning of the upper limbs and hands and loco motion.

It is also an area of potential danger as it gives bony protection two major blood vessel that supply the brain and spinal cord.

ANATOMICAL AND FUNCTIONAL SEGMENT OF CERVICAL SPINE

Anatomically and functionally the cervical spine can be divided into two segments. The upper segments :consists of the atlas and axis(c1_2). Function: It’s structure is designed for mobility with approximately one-third of cervical flexion and extension and over half of axial rotation occurring at this level

Anatomically and functionally the cervical spine can be divided into two segments. The upper segments: consists of the atlas and axis(c1_2). Function: it’s structure is designed for mobility with approximately one-third of cervical flexion and extension and over half of axial rotation occurring at this level

The lower segment: consist of the remaining cervical vertebra (c3_7) function contribute to overall mobility.

Formation of cervical spine : Cervical spine is formed by 7th vertebra and 8th pairs nerves.

Special test for cervical spine

Five special test are directly releated to the cervical spine. Distraction test. The compression test. The valsalva test. Swallowing test. Adson test.

Distraction Test

This test demonstrated the effect that neck traction might have in relieving pain. Distraction relieves pain due to a narrowing ofof the neural foramen(and the result of the nerve root compression) by widening the foramen.

Distraction also relieves pain in the cervical spine by decreasing pressure on the joint capsule around the fascet joint.

In addition;it may help to alleviate muscle spasm by relaxing the contracted muscles.

To perform the cervical spine distraction test place the open palm of one hand under the patient chin The other hand upon his occiput. Then gradually lift the (distract) head to remove it’s weight from the neck.

Compression Test

A narrowing of the neural foramen,pressure on the fascet joints,or muscle spasm can cause increased pain upon compression.in addition the compression test may faithfully reproduce pain referred to the upper extremity from the cervical spine.

Indoing so,may help locate the neurologic level of any existing pathology.

To perform the compression test press down upon the top the patients head while he is either sitting or lying down. if there is increase in pain either cervical spine or the extremity note its distribution and whether if follows any previously described the dermatome

Valsalva Test

This test increase intra-thecal pressure.If a space occupying lesion.such as a herniated disc or a tumor.is present in the cervical canal.the patient may develop pain in the cevical spine secondary to increased pressure.

The pain may also radiate to the dermatome distribution that corresponds to the neurological logical level of the cervical spine pathology.

To perform the valsalva test have the patient hold his breath and bear down as if he were moving his bowels.then ask whether he feels any increase in pain and if so whether he can describe the location.note that the valsalva test is a subjective test which requires accurate response from the patient.

Swallowing Test

Difficulty or pain upon swallwoing can sometime be caused by cervical spine pathology such as bony protuberances.Bony osteophytes or by soft tissue swelling due to haematoma,infection,or tumor in the anterior portion of the cervical spine.

Adson Test

This test is used to determine the state of the sub clavian artery which may be compressed by an extra cervical rib or by tightened scalenus anticus and scalenus medius muscle,which can compress the artey where it passes between them on its away to the upper extremity.

How to perform Adson test?

To perform the adson test check the patient radial pulse at the wrist. As you continue to feel the pulse abduct,extend and externally rotate his arm.Then instruct him to take a deep breathing.

To turn his head towards the arm being tested,if there is compression of the subcalavian artery,physiotherapist will feel a marked absence of the radial pulse.

ANY QESTIONS?