6 - Clinical examination of the cervical spine

History taking in patients with problems in the neck, trapezius or shoulder region should be as detailed as possible and great care should be taken to define every symptom precisely. Especially when a controversial treatment, such as manipulation, is to be considered, it is vital that nothing has been forgotten that could constitute a contraindication. Age may be important, because some disorders do not occur before or do typically occur at a certain period of life. For instance, torticollis in a baby is probably congenital. The same clinical picture in a 5-year-old child is more likely to be caused by contracture of the sternocleidomastoid muscle after, for example, glandular swelling or abscess formation. During and after adolescence it is more probably the result of a disc protrusion. The same argument applies to root pain. Under the age of 35 it is scarcely ever caused by a disc except after trauma, in which it may occur from 30 years upward. Radicular pain in a young person is usually the result of a neurofibroma, while in the elderly it is commonly the result of compression by an osteophyte or invasion from secondary deposits in the spine, rather than a disc protrusion. Early morning headache is typical in the elderly and is often the result of contracture in upper cervical ligaments. Headache from temporal arteritis also occurs late in life. Whenever symptoms appear in a patient of the ‘wrong’ age group, further investigation should be requested in order to exclude more serious disorders. The patient’s work, hobbies or preferred sport may give an idea of postures, movements or strains that may be causative or provocative. Cervical spine lesions may lead to the following symptoms: pain, paraesthesia, vertigo or symptoms related to the vertebral artery, and incoordination and spasticity.