VERTEBRAL COLUMN Neck


The posture of the cervical spine should be observed from the front, back and sides, noting any defect detected. Active range of motion should be observed, with the patient standing or sitting, or both. Whichever position is chosen, note it and ensure that further tests during the season are repeated in this position – this principle applies to all testing procedures. Record whether any excessive movement, pain or restrictions are present. Movements commonly tested are flexion, lateral flexion, rotation and extension (4). If the player reports symptoms of cervical artery dysfunction on sustained


neck movements (dizziness, double vision, speech problems, nausea), then further investigations are required. This is a prerequisite before any palpation of the neck (5). The test involves actively holding the neck in extension and then in extension and rotation. This is then repeated passively while monitoring the patient for vertebral insufficiency signs and symptoms (4). If this test is negative, palpation down the cervical spine is commenced, centrally and on the facet joints, noting any pain and restriction (4).


TABLE 1: DERMATOMES C1 Top of head C2 Face C3 Lateral neck C4 Lower neck and top of shoulder C5 Shoulder to base of thumb outside of arm


C6 Front of shoulder, down arm, into thumb and back of hand


C7 Back of shoulder, down back of arm, into back of hand


C8 Little finger and wrist T1 Inside elbow down to wrist L1 Back and over trochanter L2 Back and anterior thigh to knee


L3 Back, upper buttocks, anterior thigh and knee, inner lower leg


L4 Inner buttocks, outer thigh inside of leg, and dorsum of foot and big toe


L5 Buttock, back, side of thigh, lateral leg, dorsum of foot, inner half of sole of foot, and second and third toes


S1, S2 Buttock, posterior thigh and lower leg S3 Groin and inner thigh to the knee S4 Genitals


Thoracic spine


Posture is the first observation to be made, noting any increases in spinal curvature in the anterior–posterior plane and lateral plane. Movements to be assessed in the thoracic spine are flexion, extension, side flexion with the hands behind the head (upper), and side flexion with the hands across the chest (lower). Rotation and deep breathing are evaluated to assess costo-


Figure 1: Dermatomes


vertebral joint dysfunction, noting any pain and restriction to either side. This is followed by palpation of the thoracic spine (4).


UPPER LIMB


Shoulder and scapulo-thoracic joint Shoulder complex instability is common in athletes who constantly use their upper limb (9). First look at the static position of the humeral head in the glenoid and the static posture of the scapula. This is done by palpating the head of the humerus while palpating the acromion process of the scapula. The humeral head should protrude slightly anterior when compared with the acromion process (2). Observation of the scapula from a posterior view may show a difference in scapula position. The athlete may have a winging scapula from an underlying scapula-thoracic instability (9) or an altered position from a muscular imbalance (10). Next, assess the dynamic movements and stability of the scapulo-thoracic complex. Movements that should be assessed are flexion, extension, rotation medial and lateral, abduction and adduction. The same movements need to be assessed isometrically for strength (9). When assessing flexion and abduction, also observe the


8


movement of the scapula to identify the scapulo-thoracic rhythm. Normally, the scapula does not move until about 60° of shoulder elevation (11).


Special tests for the shoulder


There are a number of special tests for the shoulder aimed at discovering instability or impingement. Impingement tests include the Hawkins–Kennedy test, which assesses impingement of the supraspinatus tendon, and Neer’s test, which adds the biceps tendon. For the Hawkins–Kennedy test, the shoulder and elbow are passively flexed to 90° and then forceful medial rotation is added. For Neer’s test, the arm is passively elevated through forward flexion and medial rotation. Both tests are positive if pain is present (9). Instability tests include the load and shift test, which is performed on a relaxed and correctly postured shoulder. The examiner grasps the humeral head and stabilises the scapula with their opposite hand. The humeral head is then loaded into the neutral position and drawn in an anterior and posterior direction


sportEX dynamics 2009;22(Oct):7-11


©Primal Pictures 2009


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