The regional musculoskeletal examination (RMSE) of the neck is designed to build on the sequences and techniques taught in the SMSE and GMSE. It is intended to provide a comprehensive assessment of structure and function combined with special testing to permit you to evaluate common, important musculoskeletal problems of the neck seen in an ambulatory setting. The skills involved require practice and careful attention to technique. However, they can be learned and mastered on normal individuals.
The RMSE of the neck is clinically useful as the initial examination in individuals whose history clearly suggests an acute or chronic neck problem: neck-predominant spinal pain or upper extremity–predominant pain (possible cervical nerve root irritation). With practice, a systematic, efficient RMSE of the neck can be performed in ∼3 to 4 minutes.
Furthermore, the RMSE of the neck provides the foundation for learning additional, more refined diagnostic techniques through your later exposure to orthopedic surgeons, rheumatologists, physiatrists, physical therapists, and others specifically involved in the diagnosis and treatment of neck problems.
This instructional program will enable you to identify important anatomical features, functional relationships, and common pathologic conditions involving the neck. Essential content includes
- Structural and functional anatomy
- Cervical spine range of motion
- (Myofascial) trigger points and (fibromyalgia) tender points
- Suspected nerve root irritation
- Suspected cervical myelopathy
Most importantly, this program will prepare you to perform an organized, integrated, and clinically useful RMSE of the neck.
Structural and Functional Anatomy
The cervical spine consists of seven vertebrae, increasing progressively in size from C1 to C7.
C1 and C2 deserve special comment because they have unique features (Fig. 6–1). C1 (atlas) lacks a vertebral body but consists of anterior and posterior arches and two cup-shaped lateral masses (Fig. 6–2A). Just as in Greek mythology, Atlas was forced to bear the weight of the world on his shoulders, so the cervical atlas (C1) bears the skull on its “shoulders” (lateral masses; Fig. 6–2B), each articulating with the occipital condyles on either side of the foramen magnum at the atlantooccipital joints (Fig. 6–3A, B). These joints make small contributions to flexion and extension (nodding) and lateral flexion.
(Modified with permission from Lawry GV, Kreder HJ, Hawker G, Jerome D. Fam's Musculoskeletal Examination and Joint Injection Techniques, 2nd ed. Mosby/Elsevier, 2010, p. 105.)
C2 (axis) has a vertebral body anteriorly and from it a fingerlike peg projects ...