REIDER PART 273

Chapter 8 Cervical and Thoracic Spine 333

TABLE 8-2

TAKE HOME POINTS

PHYSICAL FINDINGS IN COMMON CONDITIONS OF THE CERN/ICAL AND THE THORACIC SPINE

1. Cemcal spine examination should include careful inspection, gait and rangę of motion testing and a thorough neurologie examination.

2. Palpation of the cen/ical spine should be performed to identify any areas of tenderness or "step-off."

3. Neurologie examination should include motor, sensory and reflex testing in the distribution of the cen/ical nerve roots.

4. Nerve tension tests are helpful at identifying pressure on a nerve root such as that caused by a herniated disk.

5. Profound or progressive neurologie deficit mandates immediate patient work-up.

Cervical Radiculopathy

Restricted rangę of motion

Radiating pain exacerbated by the axial compression test and/or the Spurling test (freąuent)

Upper limb tension test reproduces or exacerbates the patienfs familiar radicular pain

Motor, sensory, and/or reflex deficit in the distribution of the involved nerve root (variable)

Cervical Spondylitic Myelopathy (Cervical Spinał Stenosis)

Restricted rangę of motion

Lhermittes maneuver produces distal paresthesias

Broad-based gait (variable)

Lower motor neuron findings of the nerve roots at the level of the lesion (motor, sensory, and/or reflex deficit in distribution of the involved nerve root) (variablc)

Upper motor neuron deficit below the level of the lesion (hyperreflexia, ankle clonus, Babiński s sign)

Cervical Fracture

Point tenderness at the level of the injury

Palpable deformity, such as step-off or break in the normal alignment or spacing of the spinous processes Neurologie deficit (may vary from nonę or partial spinał cord injury syndromc to complete spinał cord injury)

Partial spinał cord injury syndromes include anterior cord syndrome, central cord syndrome, Brown-Sequard syndrome, and posterior cord syndrome

Cervical Strain (Whiplash Injury, Mechanical Cervical Pain)

Diffuse tenderness of the posterior neck muscles Reduced rangę of motion Normal neurologie examination strength testing, that the patients muscles suddenly give way in a nonphysiologic manner.

OVF.RREACTION

The fifth nonorganic sign of Waddell is called overrcac-tion. This sign is considered present when the patient reacts physically or verbally in an inappropriately theatri-cal manner to light forms of palpation or gentle exami-nation techniques. Again, the evaluation of this sign depends on the examiners previous experience with a hroad rangę of normal patient bchavior.

Waddells original description of the five signs was in connection with a study of patients' responses to spine surgery. Waddell noted that three or morę signs were present in patients who had had unsuccessful back surgery. Waddell also found that the most sensitive sign was over-reaction. Because the assessment of these signs is subjec-tive, their significance inereases when several are present. It should be remembered that in certain organie disease States, individual Waddell signs may bc present. This is clearly the case in the stocking distribution of numbness that can occur in the presencc of diabetic neuropathy.

The physical findings in common conditions of the cemcal and the thoracic spine are summarized in Table 8-2.

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