Examination

Examination

History – General General Demographics

Age Sex Race/ethnicity Primary language

Social History Cultural beliefs and behaviors Family and caregiver resources Social interactions, social activities and support systems

Occupation/employment: overuse, trauma, sitting…

Examination

History (contin) Growth and Development

Hand dominance Developmental history

Living Environment History of Current Condition

Reason for coming to PT Current therapeutic interventions Mechanism of injury or disease including date of onset &

course of events: MVA Onset and pattern of symptoms: acute event Patient/client, family, significant other, and caregivers

perception of patient’s current status

Examination

History (contin) Medications

Meds for current condition Meds for other condition(s)

Other tests and measures Lab and diagnostic tests Review available records Review nutrition and hydration

Past History of Current Condition Prior therapeutic interventions (manipulation) Prior meds

Examination

Past Medical/Surgical History Endocrine/metabolic Cardiopulmonary G-I G-U Integumentary MS NM Pregnancy, delivery and post-partum Prior hospitalizations, surgeries, pre-existing medical

and other conditions

Examination

Family HistoryHealth Status

General health perception Physical function Psychological function Role function Social function

Social Habits Behavioral health risks Level of physical fitness

Specific History Headaches (c-spine, AA, vestibular) Dizziness Pillow at night

Examination

Systems Review: Cardiovascular/pulmonary (HR, RR, BP, edema) Integumentary (skin integrity, skin color, scarring) MSK (UQS) Neuromuscular (balance, locomotion, transfers) Communication ability (affect, cognition, language &

learning style, orientation, etc…)

Examination

Tests and Measures Inspection

Size/Shape/Deformity Posture Atrophy Swelling Deformities (scoliosis, kyphosis) Bracing Scapular symmetry Ability to disrobe Bony landmark symmetry

Examination

Tests and Measures Inspection

Color Temperature

ROM AROM

Observe for opening or closing restriction Rotation, flexion, extension, SB, combined mvts,

sustained positions, repeated mvts PROM Measurements (bubble)

Examination

Tests and Measures Flexibility

Upper trap Scalenes Levator Pectoralis minor

Strength Assessment MMT

Deep flexors (endurance test)• Supine- chin tuck (craniovertebral flexion and lower cx flexion) occiput

approx 1 inch above table- 3 trials then test• Norms: males (40 +/-20) and females (30 +/- 14) sec’s• Reliability: 0.67 without pain and 0.87 with pain (Harris, Harris, and Olsen)

Neck extensors Neck rotators Lateral flexors

Examination

Tests and Measures Upper Cervical Stability Tests

Sharp’s Purser (transverse ligament) Pt seated, cx flexed (comfortable), examiner places palm of one hand on

pt’s forehead and the index finger of free hand on C2. Examiner pushes post on pt’s forehead. + test = reduction in sx’s, clunk or click may be felt in the roof of the mouth = reduction.

Sen 69%, spec 96% laxity > 3mm, +LR 17.3, - LR 0.32; if laxity > 4mm sen to 88% (Uitvlugt and Indenbaum 1988); RA AA most signif complication 20-70% (Kauppi M et al 1998)

Alar ligament Clinical Utility (not known)

• Pt supine, the PT grips and stabilizes C2 sp process; then C1 is SB on two; - test very little mvt; + test lag in C2 mvt; test repeated with C1 rot

Anterior Shear Test (transverse ligt test) Clinical Utility (not known)

• Pt supine, PT support head, C1 and occiput sheared anteriorly. + test sensation of lump in throat or the presence of cardinal signs

Examination

Tests and Measures Mobility

P-A glides Sidegliding AA rotation OA Flex/Ext

Smedmark et al (2000) 77% agreement for all tests using PPIVM

Jull et al (1988) PPIVM- accurately identified symptomatic joints in 15 pt’s

First rib spring testing

Examination

Tests and Measures Special tests

Vertebral artery test: sustained ext and rotation each side (Cote et al 1996) Post predictive value is 0% (portion of pop with + test who are

correctly diagnosed = 0) Hoffman’s test

Tapping of flicking the nail of the distal phalanx of 3rd or 4th finger; + test flex terminal phalanx of thumb; for cord comp sen = 58%, spec = 78% (Glaser JA et al 2001)

Spurling- 30° SB, 30° SB with compression (radiculopathy) Sen .50, spec .88, -LR .58, +LR 3.5 (Rubinstein SM et al 2007, Shah KC et al 2004)

Cervical distraction TOS

Provocative tests: sen 72% and spec 53% (Adson maneuver and Wright test); cluster findings improves spec

Adson- pt sit arms on thighs, PT palpate radial pulse, deep breathe, hyperext cx and SB Wright test- pt sitting, arm in up and back into hyperabduction (palpate pulse)

Flexion rotation (FRT)- full flexion and rotation (ave 44°); sen 90%, spec 88%, in experienced PT’s for cx headaches (ave ROM loss 17°) Hall et al 2008, Ogince M et al 2007

Sensory examination

Dermatome UE

Examination

Tests and Measures Palpation (spinous processes, transverse, mastoid,

thyroid cartilage, sternum, clavicle, scapula, carotid artery, occipital bone, 1st rib position)

References

Rubinstein SM et al., A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007:16:307-319.

Shah KC et al., Reliability of diagnosis of soft cervical disc prolapse using Spuling’s test. British Journal of Neurosurgery. 2004:18(5):480-483.

Glaser JA et al., Cervical Spinal Cord Compression and the Hoffman Sign. Iowa Orthop J. 2001:21:49-52.

Treleaven J et al., Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy, 2008:13;2-11.

Petty NJ and Moore AP. Neuromuscular Examination and Assessment (second edition) 2001: Elsevier.

Uitvlugt G and Indenbaum S. Arthritis and Rheumatism 1998:31(7):918-922. Kauppi M et al., Active conservative treatment of atlantioaxial subluxation in

rheumatoid arthritis. British J Rhem. 1998:37:417-420. Hall TM et al., Intertester Reliability and Diagnostic Validity of the Cervical

Flexion-Rotation Test. J Manipulative Physiol ther.2008;31:293-300. Ogince M et al., The diagnostic validity of the cervical flexion-rotation test in

C1/2 related cervicogenic headache. Man Ther2007;12:256-262.