The guideline recommends to stick to the following steps during your physical examination:
- In- or exclusion of Grade III neck pain (signs & symptoms of neck pain with neurological signs & symptoms) if your patient complained of neurological symptoms during patient-history taking:
- Test for a diminished biceps- and triceps reflex, diminished touch sense in the dermatomes, reduced muscle strength in the myotomes,
- To confirm cervical radiculopathy, the guideline recommends the Spurling’s test (see in a later section) and/or the traction/distraction test (see in a later section)
- To exclude radiculopathy, the guideline recommends to perform the ULTT1 (see in a later section)
- Examination of the cervical and thoracic spine, shoulder joint and shoulder girdle on following points:
- Range of Motion (ROM), direction of movement, resistance, end-feel
- Provocation or reduction of pain and radiation
- Muscle Examination:
- Length, elasticity, end-feel, sensibility on contraction and stretch and tonus
- Strength and endurance of deep neck flexors with the help of the deep neck flexor endurance test (see later section)
The guideline further recommends the following clinimetric tools:
- Numeric Pain Rating Scale (NPRS) for an average of the experienced pain in the last 24 hours from 0 to 10
- PSC scale to evaluate the impairment in ADLs
These two tools should be used at the beginning and the end of the whole treatment. It should be noted that an improvement of at least 2 points on these scales is considered as clinically relevant.
Other clinimetric tools like the Neck Disability Index (NDI) might be used according to the physiotherapist’s own opinion.
Due to the moderate validity and the risk of false positive results, the general use of x-rays, MRI, CT scans or ultrasound is not advised.
| Study | |||||
| KNGF (2016) | |||||
| Comment: This guideline is only available in Dutch at the moment. | |||||
