Degenerative Disorders can cause mechanical pain. The pain increases with activity and is relieved by rest. The physician will need to rule out a tumor or infection. In those situations, the pain is not related to activity. This pain is not relieved by rest or a collar and there will be more pain at night. Axial pain means that the pain is diffuse, localized to the midline, or referred pain to the shoulder or the scapula.
Radicular pain is associated with objective findings in a dermatomal distribution. There will be numbness, paresthesia and weakness. The pain will move down the arm, forearm and into the hands and fingers. The pain is due to herniation of a cervical disc pushing on the nerve root.
Tests for Cervical Radiculopathy
The Spurling’s test is used to assess nerve root pain. The patient should be seated with the head turned towards the affected side and the clinician standing behind the patient. Downward compressive force to the top of the patient’s head is applied. The test is positive when the compressive force being placed on the cervical spine causes radiating pain down the patient’s arm.
The shoulder abduction test is performed and the patient’s symptoms are relieved by shoulder abducting and placing the hand over the head. This test helps to differentiate between cervical spine pathology and other causes of shoulder pain. It is an important test for cervical radicular compressive disease. The relief of the symptoms occurs due to decreased tension on the nerve roots.
Cervical Spine Myelopathy
Myelopathy can occur due to compression of the cervical spinal cord. The pain is poorly defined and the pain is present for a while and usually located in the cervical spine or arm. Vague sensory or motor changes in a nondermatomal distribution. Symptoms include a slow, wide, broad based ataxic gait pattern. Upper motor neuron signs as well as spasticity with hyperreflexia.
Pathologic long tract signs will be seen consisting of the Hoffman’s, Babinski, Clonus, Finger Escape, and L’hermitte’s signs.
The Hoffman’s Sign is done by flicking the nail of the middle or ring finger to produce flexion of the index finger to the thumb.
The Babinski Sign is performed by running a sharp instrument along the lateral border of the foot from the calcaneus that produced extension of the big toe and fanning of the other toes.
The Clonus Sign uses non-voluntary sustained movement of the ankle muscles with firm passive continuous stretch.
L’hermitte’s Sign is performed with neck flexion causing electric shock sensation and paresthesia radiating into the upper and lower extremity.
A physician should always check the cervical spine in trauma patients and take precautions to protect the cervical spine. A trauma injury can vary from a whiplash injury to fracture dislocation with complete paralysis.
A physician should also be aware of malingering patients; an overreaction during the examination may be seen in the form of extreme facial expressions, sweating, or verbal responses. The patient may exaggerate their symptoms for the attempt of a secondary gain.
