OrthoNet

Cervical Spondylosis - Clinical Presentation

- the pain pattern is difficult to use as a way of sorting out what is going on in their spine; go with neurology!
- weakness, clumsiness, L’Hermitte’s
- the weakness is often greater distal than proximal

- look for ataxic, broad based gait
- motor weakness is seen in 61-68%
- reflexes are decreased in 70%
- it is sometimes difficult to sort out the exact level of neural compression

- Spurling’s Sign: rotate and extend towards the side of complaints - exacerbates the symptoms
- Axial Compression: further diminishes foraminal volume (can be done with Spurling maneuver)
- Valsalva Maneuver: may increase symptoms
- L’Hermitte’s phenomenon - electric shock down trunk and upper extremities with neck flexion

- overlapping findings are common, with many presenting without dermatomal pain pattern.

- look for upper motor neuron signs - hyperreflexia, spasticity, pathologic reflexes
- ankle clonus, Babinski’s
- Hoffman’s Reflex - flick the nail of the third finger and look for flexion of index and thumb
- Inverted Radial Reflex - testing brachioradialis reflex elicits flexion of fingers - seen with compression of both C5 cord and roots.

Level Root Motor Sensory Loss

C2-3 C3
C3-4 C4 Scapula Lateral neck, shoulder
C4-5 C5 Deltoid, Biceps Lateral arm
C5-6 C6 Wrist ext, biceps, supination Radial forearm & hand
C6-7 C7 Triceps, pronation Middle finger C7-8 C8 Finger flexion, interossei Ulnar forearm and hand
C8-T1 T1 Interossei Ulnar arm