### Date : 2024-06-22 12:18 ### Topic : Neck Pain Physical Examination #medicine #orthopedic ---- ### Neck Pain Physical Examination: Range of Motion (ROM) Tests When evaluating neck pain, it's essential to perform a thorough physical examination to assess the range of motion (ROM) of the cervical spine. These tests help determine the degree of movement restriction and identify potential underlying causes of the pain. ### 1. Flexion and Extension **Flexion:** - **Technique:** Ask the patient to tuck their chin toward their chest. - **Normal Range:** The patient should be able to touch their chin to their chest. - **Observation:** Note any pain, stiffness, or inability to complete the motion. **Extension:** - **Technique:** Ask the patient to tilt their head backward, looking up toward the ceiling. - **Normal Range:** The patient should be able to extend their neck about 45-60 degrees. - **Observation:** Look for pain, discomfort, or limited movement. ### 2. Lateral Flexion **Lateral Flexion (Side Bending):** - **Technique:** Ask the patient to tilt their head toward each shoulder without raising the shoulder. - **Normal Range:** The patient should be able to tilt their head about 45 degrees to each side. - **Observation:** Note any pain, resistance, or asymmetry in movement. ### 3. Rotation **Rotation:** - **Technique:** Ask the patient to turn their head to look over each shoulder. - **Normal Range:** The patient should be able to rotate their head about 60-80 degrees to each side. - **Observation:** Observe for pain, restricted movement, or differences between the two sides. ### 4. Spurling's Test <iframe title="Spurling's Test | Cervical Radicular Syndrome" src="https://www.youtube.com/embed/3ZSNdv0o0yk?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> **Spurling's Test:** - **Technique:** With the patient sitting, extend the neck, rotate it to the affected side, and apply gentle downward pressure on the top of the head. - **Purpose:** To reproduce radicular pain, indicating nerve root compression. - **Observation:** A positive test is indicated by pain radiating down the arm on the same side. ### 5. Cervical Distraction Test <iframe title="Distraction Test" src="https://www.youtube.com/embed/xDX_TUesdh0?feature=oembed" height="113" width="200" allowfullscreen="" allow="fullscreen" style="aspect-ratio: 1.76991 / 1; width: 100%; height: 100%;"></iframe> **Cervical Distraction Test:** - **Technique:** With the patient sitting or lying down, gently lift the head to apply traction to the cervical spine. - **Purpose:** To relieve symptoms of nerve root compression by widening the foramina. - **Observation:** A positive test is indicated by a reduction or relief of symptoms. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 45 - **Occupation:** Office Worker - **Symptoms:** Complaints of neck pain radiating to the right arm, with occasional numbness in the fingers. **Physical Examination:** **1. Flexion and Extension:** - **Flexion:** Jee Hoon Ju can touch his chin to his chest but reports slight discomfort. - **Extension:** He can extend his neck backward about 50 degrees but feels pain in the lower neck. **2. Lateral Flexion:** - **Left Side:** Can tilt his head about 45 degrees with no pain. - **Right Side:** Limited to about 30 degrees with pain on the right side of the neck. **3. Rotation:** - **Left Rotation:** Can rotate his head about 70 degrees with mild discomfort. - **Right Rotation:** Limited to 50 degrees with sharp pain radiating to the right shoulder. **4. Spurling's Test:** - Positive on the right side, with pain radiating down the right arm. **5. Cervical Distraction Test:** - Positive, with relief of symptoms when traction is applied. ### Conclusion By performing a series of ROM tests and specific diagnostic maneuvers, you can effectively assess the extent of neck pain and identify potential underlying issues. In Jee Hoon Ju's case, the findings suggest possible cervical radiculopathy, warranting further investigation through imaging studies and potentially referral to a specialist for comprehensive management.