Neck & Upper Extremity Spine Exam - Spine (2024)

Brachial plexus illustrations

• key difference between cervical and lumbar spine is

  • pedicle/nerve root mismatch

    • cervical spine C6 nerve root travels under C5 pedicle (mismatch)

    • lumbar spine L5 nerve root travels under L5 pedicle (match)

    • extra C8 nerve root (no corresponding C8 pedicle) allows transition

  • horizontal (cervical) vs. vertical (lumbar) anatomy of nerve root

    • due to the vertical anatomy of lumbar nerve root, a paracentral and foraminal disc herniation will affect different nerve roots

    • due to the horizontal anatomy of cervical nerve root, a central and foraminal disc herniation will affect the same nerve root

• alignment in sagittal and coronal plane (e.g. kyphotic cervical spine)

• prior surgical scars (e.g. prior ulnar nerve transposition or carpal tunnel surgery)

• skin defects (e.g. café au lait spots associated with neurofibromatosis)

• muscle atrophy (e.g. in a palsy, can see a decrease deltoid and biceps mass)

• palpate local tenderness on the spinal axis, asymmetric

• document range of motion in flexion, extension, rotation, and lateral bend

• may give absolute degrees or relative to anatomic landmark (e.g. chin rotates to right shoulder)

• normal range of motion of cervical spine:

  • flexion: 50°

  • extension: 60°

  • rotation: 80°

  • lateral bend: 45°

• include at least one muscle from each nerve root group (C5 to T1)

Grade sensation in C5 to T1 dermatomes

• score using ASIA grading system

• score major sensory types in all patients

  • pain (prick with sharp object such as paper clip, broken cotton swab)

  • light touch (stroke lightly with finger)

• score minor sensory types for focused exam

  • vibration

  • temperature

  • two-point discrimination

Spurling's test

• foraminal compression test that is specific, but not sensitive, in diagnosing acute radiculopathy

• performed by rotating head toward the affected side, extending the neck, and then applying and axial load (downward pressure on the head)

• test is considered positive if pain radiates into the ipsilateral arm when the test is performed for 30 seconds

Hoffman's test

• a positive test is sensitive, but not specific, for cervical myelopathy

• performed in one of two ways:

  • hold and secure the middle phalanx of the long finger, and then flick the distal phalanx into an extended position

    • Involuntary contraction of the thumb IP joint is a positive test

  • hold and secure the distal phalanx of the long finger, and then flick the distal phalanx into an extended position

    • Involuntary contraction of the thumb IP joint is a positive test

• a positive test is specific, but not sensitive, for cervical spinal cord compression and myelopathy

• test is positive when cervical flexion or extension leads to shock-like sensation radiating down the spinal axis and into arms and/or legs

• caused by guarding for pain in affected extremity due to

  • hip and knee pathology

  • severe radicular symptoms

• caused by painful arthritis of hip or gluteus medius weakness

• due to a neurologic disorder, including myelopathy

• a method of gait compensation for a foot drop (weakness of ankle dorsiflexion and toe extension)