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Physical Exam for Cervical Spondylosis

- Signs and Symptoms: (see C-spine Exam)
    - pain is earlly symptom, which may be ischemic in origin;

- Myelopathy:
     - characterized by weakness (upper > lower extremity);
     - ataxic broad based suffling gait, sensory changes;
     - rarely urinary retention;
     - myelopathy hand:
            - finger escape sign (small finger spontaneously abducts due to weak intrinsics) indicating cervical myelopathy;
     - upper motor neuron findings such as hyper-reflexia, clonus, or Babinski's sign may be present;
     - funicular pain, characterized by central burning and stinging with or w/o (Lhermitte's phenomenon - radiatineg lightening  like 
           sensations down back w/ neck flexion) may also be present w/ myelopathy;

- Radiculopathy:
     - can be associated with myelopathy;
     - can involve one or multiple roots, and symptoms include neck, shoulder, and arm pain, paresthesias, and numbness;
            - findings may overlap because of intraneural intersegmental connections of sensory nerve roots;
     - lower nerve root at a given level is usually affected;
     - Spurling's Manuever:
           - mechanical stress, such as excessive vertebral motion, may exacerbate symptoms;
           - gentle neck hyperextension with the head tilted toward the affected side will narrow the size of the neuroforamen and may exacerbate 
                  the symptoms or produce radiculopathy;
     - Shoulder Abduction Relief Test:
           - significant relief of arm pain with shoulder abduction;
           - this sign is more likely to be present w/ soft disc herniation, whereas, the test is likely to be negative with radiculopathy caused by 
                 Spondylosis (osteophyte compression)