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48

308_Chapter 8_Cervical and Thoracic Spine

point tenderness strongly suggests a fracture or a signifi-cant ligamentous disruption. Palpation of the spine is performed primarily from the posterior aspect.

Posterior Aspect

The cervical spine is most commonly palpated with the patient in either the supine or the seated position. The supine position allows the patient to relax morę com-pletely and may, thus, permit the Identification of morę anatomie detail (Fig. 8-20A). The disadvantage of the supine position is that the examiner cannot directly visualize the structures being palpated. The seated position (Fig. 8-20B) may compromise muscle relaxation, but it permits direct visualization of the area being examined. The prone position, although not widely employed, permits a compromise between the two cxtremes. If the patient is initially seen in an emergency situation, such as on an athletic field or following a motor vehicle accident, the ąuestion of preferred position is moot. In the emergency situation, the patient should be examined in the position in which he or she is first encountered until the examiner is satisfied that the possibility of an unstable cer-vical spine has been ruled out. If the examiner is unable to make this dccision with confidence, the patient should be transported to a hospital with the neck immobilized until a good radiographic evaluation can be conductcd.

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