Physical Examination 205: Cervical Spine

The complete cervical spine examination as a chiropractor performs and documents it: the nerve-root patterns of cervical disc herniation from C2 to T1; the consultation and history; visual assessment and palpation; the neurological screen with its grading scales — muscle strength 0–5, myotomes C1–T1, dermatomes C5–T2, deep tendon reflexes 0–5; active, passive and resisted range of motion and the Janda cervical flexion test; the orthopedic tests for radiculopathy and disc herniation (Rust's sign, cervical compression, flexion compression, Spurling, maximal foraminal compression, shoulder depression, distraction, shoulder abduction, Bakody's sign); the deep cervical flexor test; Hoffman's and L'hermitte's signs for myelopathy; the cervical flexion-rotation, head-neck differentiation and smooth pursuit neck torsion tests; the Romberg test; and imaging. The key tests are demonstrated on video.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a repeatable, documentable cervical examination: the order of the sequence, the grading scales that belong in the chart, and every orthopedic test with its position, procedure, positive finding and indication.

By running both halves of the neurological screen the course teaches. A compressed nerve root — cervical radiculopathy from a disc herniation — shows as weakness in one myotome, altered sensation in one dermatome, a diminished reflex at that level, and arm symptoms that reproduce with compression, Spurling or maximal foraminal compression and ease with distraction or shoulder abduction. A spinal cord problem — cervical myelopathy — shows the opposite reflex pattern, brisk reflexes or clonus, and the upper motor neuron signs the course demonstrates: a positive Hoffman's sign (thumb and index finger flexion when the middle finger's tip is flicked) and L'hermitte's sign (an electric-shock sensation down the spine on neck flexion). The distinction decides whether the patient is adjusted or referred.

Physical Examination 205 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Both cover the neck, from different directions. Dr. O'Hara's Physical Examination 202 approaches the neck and upper extremities from the injury side — stable versus unstable cervical injuries, spinal cord syndromes, shoulder, elbow and wrist conditions and their imaging. Physical Examination 205 is the examination procedure itself — the sequence, the grading scales and each orthopedic test demonstrated on video. Many clinicians take both; add Dr. Riggs' Physical Examination 204: Cerebral and Vascular Risks, the vascular screen before cervical manipulation, and the three reach 6 CE hours, where the automatic 10% discount starts ($108 instead of $120). The current series with pricing lives on the category page.