Neck (special tests)

Case 1

You are a fifth-year medical student working at a general practice clinic. Your next patient is a 42-year-old woman who works in a kindergarten and is currently on sick leave. She attends a follow-up appointment because of neck pain, which she has had for many years. Over the past two months, the central neck pain has increased and begun to radiate into her left arm. Her general practitioner has already assessed her and ordered radiographs and MRI of the cervical spine. The imaging shows a C6/C7 disc herniation compressing the spinal nerve at that level.

• Explain how you would examine this patient to find out if she has a nerve root involvement.

Neck examination

• Perform standard neck examination
  • Inspection
  • Active movement
  • Passive movement
  • Isometric movement
  • Palpation
• Perform Spurling test
• Perform plantar reflex
• Perform key examinations for radiculopathy for levels C5-Th1

Spurling test

Plantar reflex

C5

C6

C7

C8

Th1

Clinical findings

• What is the expected clinical picture in cervical radiculopathy?
• There is a positive Spurling test, interpretation?
• There is
  • Pain radiating to 3 fingers
  • Absent triceps reflex
  • Weak elbow extension strength
• Interpretation?

Cases