C2 (Axis) Fractures Clinical Presentation

Updated: Apr 07, 2022
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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Physical Examination

Neurologic assessment of C2 (axis) fractures (C2 nerve root) includes the following:

  • Motor - Muscles that have a contribution from the C2 nerve root include the sternocleidomastoid (SCM), trapezius, longus capitis, longus colli, rectus capitis anterior, splenius capitis, splenius cervicis, and semispinalis capitis
  • Sensory - The C2 nerve root provides sensory innervation to the posterior scalp, anterolateral neck, and anteroinferior and posteroinferior external ear
  • Reflexes - The SCM reflex, which may be elicited by tapping on the clavicular end of the muscle

Clinical examination includes the following:

  • Observe and palpate for deformities and step-offs
  • Test muscle strength and tone of upper and lower extremities
  • Perform sensory testing on upper and lower extremities
  • Perform rectal examination
  • Test trapezius muscles by asking patient to shrug shoulders
  • Observe for  torticollis