PREFERRED PRACTICE PATTERN
4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders1
A 45-year-old male presents with pain and stiffness in the left cervical region. He reports waking up with this condition 3 days ago. The pain is located along the left C3-4 and C4-5 spinal segments, and is aggravated by looking over the left shoulder and looking up. Increased muscle tone is present in the left levator scapula and upper trapezius muscles. No pain, numbness, or tingling in the upper extremities is noted, and neurological examination is normal. Passive intervertebral motion (PIVM) testing reveals restriction in downglide mobility of the left C3-4 facet joint. Quadrant testing is positive when combining extension, left side bending, and left rotation. Point tenderness is noted upon palpation of the left C3-4 facet joint.
Anatomy and motions of the cervical spine. (A) The skeleton of the cervical spine. (B) Motions of the cervical spine: normal range of motion exceeds the angles, which are shown as points of reference. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Flexion and extension of the cervical spine. Normal flexion brings the chin to within a fingerbreadth of the chest (A). With normal extension of the neck, an imaginary line should connect the eye, ear lobe, and shoulder (B). (From Imboden J, Hellmann DB, Stone JH. Current Rheumatology Diagnosis & Treatment. 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
The intervertebral disk, articulations, ligaments, and neurologic structures. (Reproduced with permission from Morton, DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy, McGraw-Hill; 2011.)
Diagnosis made by clinical examination
Reproduction of symptoms when joint in closed-packed position (combination of extension, side bending, and rotation toward involved side)