Cervical spine evaluation

Baker C, Kadish H, Schunk JE (1999) Evaluation of pediatric cervical spine injuries. Am J Emerg Med 17 230-234... 

Berlin L (2003) CT versus radiography for initial evaluation of cervical spine trauma what is the standard of care AJR Am J Roentgenol 180 911-915 Buckwalter KA, Rydberg J, Kopecky KK, Crow K, Yang EL (2001) Musculoskeletal imaging with multislice CT. AJR Am J Roentgenol 176 979-986... 

Whole-body CT (WB-CT) protocols in multisystem trauma usually consist of a non-contrast enhanced head CT, which is followed by a contrast-enhanced chest and abdominal CT. For evaluation of the spine, reformations from the chest and abdomen are of diagnostic image quality if the primary colUmation was 2.5 mm or less, and dedicated scans of the spine are not obligatory (Mann et al. 2003). The cervical spine can be scanned separately with thin coUimations after the head scan, or can be included in the chest scan. The latter option has the advantage that the cervical vessels are contrast-enhanced, and vascular injuries can be ruled out from the same dataset, sparing one additional scan. 

Evaluation of the cervical spine begins with a history of the patient s symptom and a thorough examination of the patient. A history of trauma to the neck is especially important. Pain and decreased range of motion are the most common complaints relative to the cervical spine. 

In the evaluation of the cervical spine for somatic dysfunction, the intersegmental motion between vertebrae is extremely important. There are several ways the cervical spine may be tested for individual vertebral motion. For all these methods, the patient will be supine with the physician seated at the head of the table. 

Other types of headaches, including migraines, often have elements of muscle tension and somatic dysfunction. Somatic dysfunction of the upper cervical spine causes pain behind the eyes. Migraine headaches are frequently associated with abnormal motions or restrictions of the temporal bones. Any patient with headache should be evaluated for somatic dysfunctions of the cranium and cervical spine with treatment of any found. 

Temporomandibular joint (TMJ) dysfunction may be caused by or may cause dysfunctions of the cervical spine. The neck must always be evaluated in cases of TMJ pain and restriction of motion. The sternocleidomastoid muscle is often involved in these dysfunctions along with the muscles of mastication. 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

All patients with a history of shoulder problems must be evaluated for dysfunctions of the cervical spine, upper thoracic spine, sternum and upper ribs. 

When evaluating a patient for shoulder pain, it is imperative to remember that all shoulder pain does not indicate intrinsic shoulder problems but may be caused by some extrinsic source such as referral from some cervical spine pathology, myocardial infarction, pleurisy or irritation of the diaphragm by the gall bladder, an abscess, or a gas bubble after laparoscopic surgery. 

Prolonged muscle contraction of scalp, face, and neck muscles is a major contributing factor in tension headache. This is often associated with reflex vasoconstriction of superficial vessels. The patient may experience a "band-like" pain around the head or pain in occipital region. The pain is usually bilateral and unaccompanied by nausea and vomiting. The upper cervical spine is often involved in head pain and must be evaluated in the headache patient. 

The musculoskeletal system is intimately involved in tension and migraine headaches. The muscle involvement in tension headache is obvious and includes the muscles of the head and face, the cervical spine, and the upper thorax. Somatic dysfunction of the occipito-atlantal joint, the atlanto-axial joint, and C2 on C3 are frequent sources of headache. The levator scapula, with its attachments to the scapula and the cervical spine, and the trapezius must be considered. Facial muscles may be the major source of head pain. The patient must be evaluated for bruxism, teeth grinding, or jaw clenching, which affects the temporalis and masseter muscles. Bruxism may lead to dysfunction of temporal bone motion or to problems with the temporomandibular joint. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

The primary focus of the initial treatment was to perform a full evaluation for primary and secondary sites of somatic dysfunction. Although the primary concern of the patient was the cervical region, it was important to correct any structural problems affecting the other parts of the body. Soft tissue and muscle energy techniques were complemented with moderate velocity-low amplitude (MVLA) techniques except for the cervical spine, where myofascial release techniques were the primary modality used. Trapezius inhibition techniques were performed with a compression myofascial technique to the right trapezius. 

Some further future goals are to include other areas of the spine, e.g., thoracic and cervical regions. We are also working on a finite element-compensation model for pre-op planing to estimate post-op changes and therefore allow a qualitative evaluation of the clinical concepts in this field. 

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