Examination: Paravertebral tenderness on the affected segments, suboccipital and/or at the upper margins of the trapezoid muscle. In part increased muscle tone in the paravertebral muscles and myogelosis. Deviations from the perpendicular (Fig. 1.1). Movement impairments (rotation and sideways tilt) often unilateral (Figs. 1.2, 1.3, and 1.4). In the case of simple blocks, the traction test brings relief (Fig. 1.6). After whiplash injury, the cervical spinal can be tender when compressed (Fig. 1.5). Pain that radiates into the arm, as well as dysesthesia, can often not be pinpointed to certain segments. When the upper segments are involved, a gaze-evoked nystagmus can often be seen. The deep tendon reflexes are normal.

DD cervicocranial syndrome: Vertebral artery syndrome, de Kleijn (Fig. 1.12) positive—patient lies prone on the examination table. Passive retroflexion, tilt, and rotation of the cervical spine to the affected side. After a few seconds, patient complains of vertigo, caused by a compression of the vertebral artery of this side.

Examination: (Acute) Wry neck. Gaze-evoked nystagmus (upper segments). Suboccipital and paravertebral tenderness. Positive compression test (Fig. 1.5). Movement impairment of the cervical spine. Sensory loss and paresis. Absent reflexes or side difference.

Somatosensory loss (. Fig. 1.11 ) that can be traced back to a certain dermatome is a sign of damage to the specific root. The region of the deltoid muscle is supplied by C5; the outer part of the upper limb and the radial part of the lower limb including the thumb are supplied by C6. Lateral and dorsal to C6 and the fingers II–IV are supplied by C7. The ulnar hand and the little finger are supplied by C8.

Absent or depressed reflexes can be a neurological sign of root damage.

The biceps reflex (Fig. 1.8) communicates with the C5 root, the brachioradialis reflex with (Fig. 1.9) C6, and the triceps reflex with (Fig. 1.10) C7 und C8.

Examination: Reduced mobility of the cervical spine (Figs. 1.2, 1.3, and 1.4). Sensory loss is not characteristic (mostly absent, but can also present similar to losses seen in radicular or spinal trauma). Motor loss in the form of paresis (symmetrical or unilateral) or spastic tetra- or paraplegia. Deep tendon reflexes (Figs. 1.41 and 1.42) are increased; the Babinski sign is positive (Fig. 1.43), possibly also the Gordon and Oppenheimer signs (Figs. 1.44 and 1.45). The “myelopathic hand” could also possibly be seen: thenar, hypothenar, and interosseous muscle atrophy.

Sweat secretion upon pilocarpine or a histamine test (local flush reaction). For this one must consider that the sympathetic nerves originate below T3. If the vegetative innervation of the upper extremity is intact (sweat secretion, localized flushing), root damage is almost certain. Plexus lesions can, however, also be combined with root damage.

Examination : Shoulder, active abduction and outer rotation M0; elbow, active flexion and supination M0. Hypesthesia (Fig. 1.11) over the deltoid muscle and the radial side of the lower arm.

Examination: Shoulder, active abduction and outer rotation M0; elbow, active extension/flexion as well as pronation reduced. Hypesthesia (Fig. 1.11) over the deltoid muscle and the radial side of the lower arm and the hand.

Examination: Paresis of the small hand muscles (e.g., lumbrical muscles) and the long finger flexors. Ulnar claw (Fig. 2.​46). Sensory loss on the ulnar side of the lower arm and hand is always present under cervical impingement syndrome (Fig. 1.11). Often accompanied by Horner’s syndrome (Fig. 1.7).

DD: Pancoast tumor (pain-free); neuralgic shoulder amyotrophy; “backpack palsy” (Fig. 1.24)(due to carrying a heavy load on the shoulders); less common is thrombosis in the axillar vein, occlusion of the brachial artery.

Examination: Pain can be provoked by turning the head to the healthy side. This causes loss or weakening of the radial artery pulse and hypesthesia in the fourth and fifth digit (Fig. 1.11).

Examination: Positive Adson test (Fig. 1.13). This test involves turning and lifting the head toward the affected side while the patient simultaneously inhales deeply and the ipsilateral arm is pulled in a caudal direction. Sensory loss in the fourth and fifth digit and the lateral hand. Finger abduction and adduction are limited.

Examination: Positive Adson test (Fig. 1.13). This test involves turning and lifting the head toward the affected side while the patient simultaneously inhales deeply and the ipsilateral arm is abducted up to the horizontal plane and pulled backward. Sensory loss in the fourth and fifth finger and the lateral hand.