Conditions Affecting The Cervical Spine - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the conditions affecting the cervical spine.
1-Degenerative disorders: can cause mechanical pain, the pain increases with activity and is relieved by rest. Rule out tumor, rule out infection. In these situations the pain is not related to activity. The pain is not relieved by rest or a collar and there will be more pain at night. Pain at night usually not normal. Is the pain axial or radicular? 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 weakness and paresthesia. 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.
Test for cervical radiculopathy
•Spurling’s test: 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.
•Shoulder abduction test: the patient’s symptoms are relieved by shoulder abduction and placing the hand over the head. This test helps to differentiate between cervical spine pathology and other causes of shoulder pain. It is important for cervical radicular compressive disease. The relief of the symptoms occurs due to decreased tension on the nerve roots.
2-Cervical spine myelopathy: myelopathy can occur due to compression of the cervical spinal cord. Pain is poorly defined. The pain is present for a while and usually located in the cervical spine or arm. Vague sensory or motor changes in a dermatomal distribution. Symptoms and examination include slow, wide, broad based ataxic gait pattern. Upper motor signs as well as spasticity with hyperreflexia. Pathological long tract signs will be seen consisting of the Hoffman’s, Babinski, Clonus, Finger Escape and L’hermitte’s signs.
•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.
•Babinski sign: running sharp instrument along the lateral border of the foot from the calcaneus produces extension of the big toe and fanning of the other toes.
•Clonus sign: nonvoluntary sustained movement of the ankle muscles with firm passive continuous stretch.
•L’hermitte’s sign: neck flexion causing electric shock sensation and paresthesia radiating into the upper and lower extremity.
Always check the cervical spine in trauma patients. Take precautions to protect the cervical spine. Injury can vary from whiplash injury to fracture dislocation with complete paralysis.
Be aware of malingering patients. Overreaction during 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 secondary gain.
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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step

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