Neurological testing

Neurological testing

Dermatomes

Test for normal sensation, the cutaneous area supplied by a single posterior root of each spinal segment, light touch with the dorsal aspect of the hand or cotton wool and pinprick sensation for each dermatome, C1 to T1.

Myotomes

Isometric testing of the muscles supplied by a spinal segment in mid range for a few seconds is performed at each level from C1 to T1. Weakness may

indicate a lower motor lesion from a prolapsed disc or another space-occupying lesion.

Reflexes

Test for normal reflexes: biceps (C5–C6), triceps and brachioradialis (C7). Compare one side with the other. Note brisk reflexes which may be indicative of an upper motor neurone lesion and dull reflexes which may be indicative of a lower motor neurone lesion.

C5–C6 correspond to biceps brachii. The person’s arm should be semi-flexed at the elbow with theforearm pronated. Place your thumb or finger firmly on the biceps tendon and hit your finger with the hammer.

C6–C8 correspond to triceps. Support the person’s upper arm and let the forearm hang free. Hit the triceps tendon above the elbow.

Mechanical tension tests

The upper limb tension test (ULTT) is referred to as the SLR test of the cervical spine. This test mobilises the brachial plexus and particularly biases the median nerve to determine the degree to which neural tissue is responsible for producing the patient’s symptoms. Certain movements

of the arm, shoulder, elbow, wrist and hand, and, similarly, the neck and the lower limb, can cause neural movement in the cervical spine. These tests are so important that all physiotherapists should know and use them (Butler 1991).The physiotherapist depresses the patient’s shoulder, then adds in 90 degrees abduction, 90 degrees lateral rotation of the shoulder, elbow extension, forearm supination, and wrist and finger extension to the supine patient. Sensitising manoeuvres such as ipsilateral (same side) or contralateral (opposite side) cervical rotation and side flexion are added. Symptoms

Pain, paraesthesia and restriction are noted and compared with the other side. Common findings will be reduced range or the reproduction of symptoms on the affected side.

Palpation

Palpate the soft tissues, noting the positions of vertebrae and myofascial trigger points (localised irritable spots within skeletal muscle). These trigger points produce local pain in a referred pattern and often accompany chronic

musculoskeletal disorders. Palpation of a hypersensitive nodule of muscle fibres of harder than normal consistency is the physical finding typically associated with trigger points (Alvarez and Rockwell 2002).

Observe for local or referred pain, thickening of structuresor stiffness. Remember that anomalies of the bifid spinous processes of the cervical vertebrae and differences in their spacing are not uncommon and may not be clinically significant (Maitland 2001). Soft-tissue changes, including sub-occipital thickening and shortening in the extensors and prominence, and

thickening of the articular pillar of C2–C3 facet joints, are common in degenerative disorders. Soft-tissue changes around the cervicothoracic junction are also commonly found and may be referred to as a Dowager’s hump.

Bony anomalies

Osteophytes may be palpable at the C2–C3 facet joints in patients with pre-existing spinal pathology (Maitland 2001). Approximation of the spinous processes of C6–C7 is also a common feature.

Accessory spinal movements

With the patient prone, central pressure on the spinous processes C2–T6 and unilateral pressures on the articular

pillars C2–T6 is applied by the physiotherapist, noting

levels of stiffness, pain response, muscle spasm and areas

of hypermobility.

 

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