Physical Examination for Cervical Spondylosis The visit is to see the patient, not just the films. Asking about the condition and physical examination in person is very important and can provide very important information. Wu Yongchao, Department of Orthopedics, Wuhan Union Hospital The main physical examinations for cervical spondylosis are as follows: (1) Pressure and pain points (2) Cervical spine range of motion examination Patients with general neurogenic and cervical cervical spondylosis are prone to limited cervical flexion, extension and rotation activities. (3) Special test examination of the cervical spine. (1) Forward flexion and rotation test: first, let the patient’s head and neck flex forward, then rotate to the left and right, and if the cervical spine is painful, it is positive. Positive results generally indicate degeneration of the small joints of the cervical spine. Intervertebral foramen squeeze test: also known as head compression test. The patient is asked to tilt his head to the affected side and the examiner taps or presses the top of the patient’s head. If there is a nerve root injury, there will be sensations such as radiating pain or numbness in the limb due to the narrowing of the intervertebral foramen. Brachial plexus pull test: The patient sits with the head slightly flexed forward and turned to the healthy side (asymptomatic side of the neck), the examiner stands on the affected side, puts one hand against the top of the cervical side and pushes it to the healthy side, the other hand holds the patient’s wrist and pulls it to the opposite direction, if the patient has numbness or radiating pain, it is positive, indicating the possibility of neurogenic cervical spondylosis. ④Cervical rotation test: also known as vertebral artery distortion test, mainly used to determine the status of the vertebral artery. The specific method is to tilt the patient’s head slightly backward and rotate the neck to the left or right, which is positive if vertigo and other vertebrobasilar artery insufficiency occurs. (4) Muscle tone and muscle strength examination. ① Muscle tone: that is, the resistance encountered in passive movement when the muscle is relaxed. (2) Muscle strength: Patients with cervical spondylosis may have weakened or atrophied or weak muscles such as deltoid, biceps, triceps and small muscles of the hand due to different degrees of damage to the nerve roots or spinal cord. In addition, patients with cervical spondylosis who have long-term cervical muscle spasm and restricted movement can also affect the strength of cervical muscles, such as sternocleidomastoid and trapezius muscles, to some extent. (5) Reflex and pathological reflex examination. Reflexes – generally include biceps reflex, triceps reflex brachioradialis reflex, etc. Commonly used pathological reflexes include Hoffman’s sign, palmar chin reflex, Babinski’s sign and so on. All of these pathological reflexes are caused by damage to the superior neurons, which can lead to hyperactive segmental reflexes or even the reproduction of reflexes that have been suppressed. When performing pathological reflex examination, it is important to observe whether there are abnormalities in both deep and superficial reflexes. For Hoffman’s sign, it is important to note that a few normal people can also have positive reflexes, and it is only clinically significant when there are obvious positive reflexes or asymmetry on both sides. Imaging of cervical spondylosis After cervical spondylosis is suspected through symptoms and physical examination, imaging is needed to confirm it.1 X-ray General examination, with the advantage of being quick, can provide basic information such as the presence or absence of changes in cervical curvature, narrowing of the intervertebral space, bone stumps, stability, etc.2 Magnetic resonance imaging (MRI) The advantage is that it can directly see the spinal cord, nerve roots, blood vessel compression, and whether there is degeneration of the spinal cord.2 CT The advantage is that it can provide detailed information on all the bony morphological structures of the cervical spine as a supplement to MRI (magnetic resonance imaging). Each of these three has its own strengths and are not interchangeable.