The neck and cervical spine

Various aspects of the examination of the neck are described in Chapter 2 (cervical lymph glands, p. 58; thyroid gland, p. 62). Chapter 3 (carotid pulse, p. 83 and jugular venous pulse, p. 88) and Chapter 8 (neck movements p. 268). In particular, a neurological assessment may be incomplete without testing active and passive movements of the cervical spine, especially side rotation and flexion for obvious reasons.

Degenerative arthrosis of the ccrvical spine is common, especially in the middle-aged and elderly. Such patients may develop neck pain, long tract features or radicular symptoms.

• Flexion of the neck sometimes evokes electric shock-like sensations which shoot into the limbs, when the cervical spinal cord sensory tracts are diseased (Lhermitte's .sign). This phenomenon is particularly common in multiple sclcrosis but is also seen in syringomyelia, cervical cord tumours and spondylotic myelopathy.

• Neck movements are restricted by meningeal irritation. Meningeal irritation. Inflammation of the meninges due to infection or blood evokes reflex spasm in the paravertebral muscles. This results in ncck stiffness in the cervical ;uea. In the lumbar area muscle spasm may produce a positive Kernig's sign.

Evidence of meningeal irritation should be looked for in any patient in whom meningitis or subarachnoid haemorrhage is a possibility. The signs, however, may be absent in the early evolution of a subarachnoid haemorrhage or in the deeply comatose patient.

Examination sequence

Neck stiffness

□ Ask the patient to lie supine and to relax the head onto a single pillow.

□ Support the occiput with both hands and gently tlex the neck until the chin touches the chest - Kernig's .sign.

□ Ask the patient to lie supine with both legs exposed and fully extended.

□ Passively flex one leg at the hip and the knee.

□ Then extend the knee while maintaining the hip in flexion and observe the other limb for reflex flexion at the hip -Kernig ",t test.

If neck stiffness is present it is not possible to passively tlex the neck sufficiently for the chin to reach the chest. Indeed, attempted ncck flexion may cause the trunk to rise from the bed (Fig. 6.8A). When Kemig's test is positive, attempts to extend the knee joint when the hip joint is llexed are resisted by hamsiring muscle spasm and the other limb may flex at the hip (Fig. 6.8B).

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Essentials of Human Physiology

Essentials of Human Physiology

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