Clinical assessment

History must determine:

• The nature of the symptoms - have they been experienced before or do they represent an exacerbation of recurrent symptoms? Does the pain wake the patient at night? Are there any associated systemic symptoms or neurological deficits involving the limbs?

• If there has been recent or past trauma to the cervical spine, particularly from road traffic accidents.

• If the patient has experienced weight loss, development of swellings in the neck, tumours involving other body systems.

The neck should be inspected for any deformity, swelling, scars, etc. This is followed by palpation, both anteriorly and posteriorly, looking for tender areas or masses. These may be inflammatory masses arising from the prevertebral region or cervical nodes. The supraclavicular fossae should be examined bilaterally, looking for masses which may be swollen lymp nodes or a cervical rib.

Examination should involve assessing the range of movement of the cervical spine in six directions: flexion, extension, lateral rotation to the left and right, and lateral flexion to the left and right. It should be determined if any or all such movements are restricted and to what extent and whether they exacerbate the patient's pain. If the pain is diffusely referred to the shoulder girdle, movement of the shoulder should be assessed to see if this is restricted or reproduces the pain.

An accurate neurological examination of the upper and lower limbs should include a detailed motor and sensory examination and including superficial and deep tendon reflexes. Examination for long-track signs suggestive of cervical myelopathy is also vital together with an assessment of sphincter function.

Figure 22.33. Cervical spondylosis.
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