Physical Exam for Cervical Spondylosis

- Signs and Symptoms: (see C-spine Exam)
    - pain is earlly symptom, which may be ischemic in origin;

- Myelopathy:
     - characterized by weakness (upper > lower extremity);
     - ataxic broad based suffling gait, sensory changes;
     - rarely urinary retention;
     - myelopathy hand:
            - finger escape sign (small finger spontaneously abducts due to weak intrinsics) indicating cervical myelopathy;
     - upper motor neuron findings such as hyper-reflexia, clonus, or Babinski's sign may be present;
     - funicular pain, characterized by central burning and stinging with or w/o (Lhermitte's phenomenon - radiatineg lightening  like 
           sensations down back w/ neck flexion) may also be present w/ myelopathy;

- Radiculopathy:
     - can be associated with myelopathy;
     - can involve one or multiple roots, and symptoms include neck, shoulder, and arm pain, paresthesias, and numbness;
            - findings may overlap because of intraneural intersegmental connections of sensory nerve roots;
     - lower nerve root at a given level is usually affected;
     - Spurling's Manuever:
           - mechanical stress, such as excessive vertebral motion, may exacerbate symptoms;
           - gentle neck hyperextension with the head tilted toward the affected side will narrow the size of the neuroforamen and may exacerbate 
                  the symptoms or produce radiculopathy;
     - Shoulder Abduction Relief Test:
           - significant relief of arm pain with shoulder abduction;
           - this sign is more likely to be present w/ soft disc herniation, whereas, the test is likely to be negative with radiculopathy caused by 
                 Spondylosis (osteophyte compression)

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 25, 2011 11:07 am