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Abstract
Palpitation is an important component of a comprehensive musculoskeletal and neurologic examination of the cervical spine in individuals with neck pain, but examiners should not base diagnostic conclusions (eg, facetogenic pain) and interventional procedures on palpatory findings alone. A methodological approach to palpation of the posterior neck includes evaluation of the paraspinal musculature, the tissues that overlie the facet (zygapophyseal) joints, and the midline spinous processes. Although studies have shown low interexaminer reliability, palpation is an important component of the physical examination for determining general anatomic regions of symptoms and in establishing rapport with the examinee. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, the diagnosis-related estimate (DRE) or injury method lists both muscle spasm and muscle guarding as potential physical exam findings by palpation. In this edition, the range-of-motion method for rating spinal impairment states that an examiner cannot find muscle spasm on exam and rate the individual's impairment on the same day because, by definition, the individual is not at maximum medial improvement. Despite acceptance by the AMA Guides, Fifth Edition, neither spasm nor guarding appears to be a reliable finding on palpation. The AMA Guides, Sixth Edition, provides a different method for determining spinal impairment, and the authors recommend limiting physical examination findings used in impairment rating to those with acceptable interrater reliability.
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1.
Seffinger MA, Najm WI, Mishra SI, et al.Reliability of Spinal Palpation For Diagnosis of Back and Neck Pain: A Systematic Review of the Literature. Spine. 2004;29:E413–E425.
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Mior SA, King R, McGregor M, et al.Intra and Interexaminer Reliability of Motion Palpation In the Cervical Spine. J Can Chiropr Assoc. 1985;29(4):195–198.
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Myburgh C, Larsen AH, Hartvigsen J. A Systematic, Critical Review of Manual Palpation for Identifying Myofascial Trigger Points: Evidence and Clinical Significance. Arch Phys Med Rehabil. 2008;89:1169–1176.
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Wolfe F, Simons DG, Fricton J, et al.The Fibromyalgia and Myofascial Pain Syndromes: A Preliminary Study of Tender Points and Trigger Points In Persons with Fibromyalgia, Myofascial Pain Syndrome and No Disease. J Rheumatol. 1992;19:944–951.
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Tough EA, White AR, Richards S, Campbell J. Variability of Criteria Used to Diagnose Myofascial Trigger Point Pain Syndrome—Evidence From a Review of the Literature. Clin J Pain. 2007;23:278–286.
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Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N. Reliability of Physical Examination for Diagnosis of Myofascial Trigger Points: A Systematic Review of the Literature. Clin J Pain. 2009;25:80–89.
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Shin S, Yoon DM, Yoon KB. Identification of the Correct Cervical Level by Palpation of Spinous Processes. Anesth Analg. 2011;112:1232–1235.
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Nassr A, Lee JY, Bashir RS, et al.Does Incorrect Level Needle Localization During Anterior Cervical Discectomy and Fusion Lead to Accelerated Disc Degeneration? Spine 2009;34(2):189–192.
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King W, Lau P, Lees R, et al.The Validity of Manual Examination In Assessing Patients with Neck Pain. Spine J. 2007;7(1):22–26.
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Siegenthaler A, Eichenberger U, Schmidlin K, et al.What Does Local Tenderness Say About the Origin of Pain? An Investigation of Cervical Zygapophysial Joint Pain. Anesth Analg. 2010;110(3):923–927.
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Sobel JB, Sollenberger P, Robinson R, et al.Cervical Nonorganic Signs: A New Cliniacl Tool to Assess Abnormal Illness Behavior In Neck Pain Patients: A Pilot Study. Arch Phys Med Rehabil. 2000;81:170–175.
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Harell A, Mead S, Mueller E. The Problem of Spasm in Skeletal Muscle. JAMA. 1950;143(7):640–664.
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Johnson EW, The Myth of Skeletal Muscle Spasm. Am J PM&R 1989;68(1):1.
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May S, Littlewood C, Bishop A. Reliability of Procedures Used in the Physical Examination of Non-Specific Low Back Pain: A Systematic Review. Australian J of Physiotherapy. 2006;52:91–102.
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Waddell G, McCulloch JA, Kummel E, Venner RM. Non-Organic Physical Signs In Low Back Pain. Spine. 1980;5:117–125.
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