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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