A 56-year-old male presents with complaints of right-sided neck pain with radiation down the right arm into the right index finger and thumb. He reports a recent fall from a scaffold while painting on the job
On physical examination, you note a 0/4 biceps reflex on the right compared to 2/4 on the left and 1/5 grip strength of the right hand compared to 5/5 of the left hand. Which of the following is a test that can be performed to assist in the diagnosis of cervical disk herniation?
A. Spurling's sign
B. Apley's sign
C. Lhermitte's sign
D. A and C
ANS: D
In cervical spine trauma, cervical disk herniation can occur. A positive Spurling's sign is noted if this maneuver reproduces neck and radicular pain, suggesting a herniated disk. Spurling's sign is tested for by lightly pressing downward on the top of the patient's head while tilting back and toward the side of pain. Lhermitte's sign may support suspicion of a herniated disk. This test is conducted by having the patient flex the neck in a chin-to-chest motion and is positive if an electric shock-like sensation down the spine results.
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