The cervical spine consists of 7 vertebrae that give rise to 8 cervical nerves and two plexuses - the cervical and brachial plexuses. The document then provides details on the history, physical examination, and investigations for cervical, thoracic, and lumbar spine conditions. It lists the nerves associated with each region and describes red flags, movements tested, and special tests like Schober's test and straight leg raise test in the physical examination.

2. Cervical spine
Consist of 7 vertebra
8 nerves
Give two plexuses
Cervical plexus ( C1-C5)
brachial plexus ( C5-T1)
Phernic ( C3,C4,C5)
mucocutanous n (C5-C7)
Lesser occipital (C2)
axillary n (C5-C6)
Supraclaviclular ( C3,C4)
median n (C5-T1)
radial N (C5-T1)
ulnar n (C8-T1)

3. Cervical spine
History
*
acute trauma
History of Falling down , vehicle accident .
Any patient unconious form after heard injury you should assumed it as cervical
spine injury.
ABC, WAIT FOR help , x –ray frontal & lateral

4. Cervical spine
History
* PAIN
:- analysis of pain
Acute ,sub acute ,chronic
Onset ,duration , character , severity ,radiation ,reliving ,aggravating factor
At end of day /at night , other joint affected
*Weakness in upper limb
*Paraesthesia

5. Cervical spine
History
Pain and difficulty turning the head and neck, examples are:
→ Disease of atlanto-occipital joints produces pain radiating to the occiput.
→ Spondylosis of the middle and lower cervical spines causes pain radiating to
the upper border of trapezius, interscapular region, and the arms.
→ Irritation of the C6 & C7 nerve roots can give rise to referred pain in the
interscapular region, radial fingers, and thumb.
→ Irritation of C8 can cause pain on the ulnar side of forearm, ring, and little
fingers.

7. Cervical spine
Physical examination:
Look
Observe the posture of the head and neck and note any abnormality and
deformity, e.g. loss of lordosis.
Feel
→ The midline spinous processes
→ The paraspinal soft tissues
→ The supraclavicular fossae – for cervical ribs or enlarged lymph nodes
→ The anterior neck structures including the thyroid

8. Move:
→ Assess active movements:
o forward flexionPut your
chin on your chest
o Extensionlook upwards
at the ceiling as far back
as you can
o Lateral flexionPut your
ear onto your shoulder
o Lateral
rotationLook
over
your
right/left
shoulder

9. →occiput to wall test
→ Gently perform passive movements if there are
reduced active movements and see if the end of the
range has a sudden or gradual resistance and whether
it is pain or stiffness that restricts movements

10. Cervical spine
Physical examination – Cont. ( Neuro exam):
Movement
C5- shoulder abduction
C6 – elbow flexion
wrist extension
C7- wrist flexion
REFLEXES:Deltoid (C5)
BICEPS (C6)
TRICEPS (C7)
Sensory
C2,C3 neck shoulder
C3,C4 shoulder posterior
ARM
Medially T1
Laterally C5 ,C6
FOR ARM
T1 MEDIALLY
C6 laterally
HAND
Lateral C6
Middle finger C7
MEDIALLY C8

11. Thoracic spine( T1-T12)
History
→ Commonly, localized spinal pain, examples are:
 Ankylosing spondylitis produces pain in the thoracolumbar region
 Acute thoracic spinal pain may be due to vertebral prolapse due to
malignancy, or infection; especially if there was systemic upset or fever
is present
→ Less commonly, symptoms of paraparesis including sensory loss,
leg weakness, and loss of bladder or bowel control

12. Thoracic spine
Physical examination:
Look
With the patient standing, inspect posture from behind, the side and the
front, noting any deformity, e.g. rib hump or abnormal curvature.
Feel
→ The midline spinous processes
→ The paraspinal soft tissues
→ If there is increased prominence of one or more spinous processes
implying anterior wedge-shaped collapse of the vertebral body – often
related to osteoporosis.
Move
Ask the patient to sit with arms crossed, and to twist round and look at you.

13. Lumbar spine
LUMBAR NERVES( L1-L5)
SACRAL NERVES ( S1-S4)
LUMBAR PELUXES ( L1-L4)
illioingunal (L1) , iliohypogastric (L1) , genitofemoral (L1-L2), Femoral (L2-L4)
Obuturator (L2-L4)
SACRA L PELUXES
SCIATIC NERVE (L4 –S3)
1- Common peroneal
2- Tibia

14. Lumbar spine
SCITICA :- PAIN extend from buttock , poster-lateral of leg , lateral aspect of foot
Common risk factor :-
1-Herniated disc
2- pregnancy
3-osteoarthritis
4- wrong IM INJECTION

15. Lumbar spine
History
→ Low back pain is an extremely common complaint
→ Sacroilitis produces pain that is referred down both legs to knees
→ Consider abdominal and retroperitoneal pathology, e.g. abdominal
aortic aneurysm, pancreatitis, peptic ulcer, renal pathologies.

16. Lumbar spine
Red flag features for acute low back pain:
→ In History:
 Age < 20 yrs or > 55 years
 Recent significant trauma (fracture)
 Pain:
 Thoracic (dissecting aneurysm)
 Non-mechanical (infection/ tumor/pathological fracture)
 Fever ( infection)
 Difficult micturition
 Fecal incontinence
 Motor weakness
 Saddle anesthesia
 Sexual dysfunction
 Gait change ( cauda equina syndrome)
 Bilateral sciatica

17. Lumbar spine
Red flag features for acute low back pain:
→ In Past medical History:
 Cancer ( metastasis.)
 Previous steroid use (osteoporotic collapse)
→ In Systemic review:
Weight loss/malaise without obvious cause (e.g. cancer)

18. Lumbar spine
Physical examination:
Look
Examine the patient standing. Look for obvious abnormality such as
decreased/increased lordosis, obvious scoliosis soft tissue abnormalities
such as a hairy patch or lipoma that overlie spina bifida.
Feel
Palpate the spinous processes and the paraspinal tissues. The L4/L5
interspinous space is palpable at the level of iliac crests.

19. Move
→ Flexion: ask the patient to
try to touch his toes with his
legs straight
→ Extension: ask the patient to
straighten up and lean back as
far as possible
→ Lateral flexion: ask the
patient to reach down to each
side touching the outside of the
leg as far down as possible
while keeping the legs straight

20. LUMBER SPINE
Physical examination – Cont. ( Neuro exam):
Movement
L2- hip flexion
L3 – Knee extention
L4-dorsiflexion
S1-planterflexion
REFLEXES:Quadriceps (L3-L4)
Achilles (l5-s1)
Sensory

21. Lumbar spine
Physical examination-Cont.:
Special tests:
 Schober’s test for forward flexion
 Root compression tests:
 Straight leg raise
 Tibial nerve stretch test
 Femoral nerve stretch test
 Flip test
 Sacroiliac joints test

22. Lumbar spine
 Schober’s test for forward flexion
 1- Erect position.
 2- Select 2 bony points,10cm apart and mark it.
 3-Maximum flexion on lumbar with fix knee.
 4-the two points should separate by at least a further 5cm.

23. Schober’s test

24.  Straight –Leg raising test
-knee straight,slowly lifted the leg.
-note for any tightness and pain in
the buttock (around 80-90 )
-passive dorsiflexion,increase the
pain.
-bow-string sign : bending the knee
slightly,release the pain.then
apply firm pressure behind
lateral hamstring,pain will recur.
-

25. • Hematological : erythrocyte sedimentation rate, complete
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blood count
Biochemical : C-Reactive protein , Ca level , ALP
Serological : RF , ANA
X- ray
CT scan
MRI
Isotope bone scan
Ultrasound