DON’T flex that pain in the neck
Never flex the neck of a young toy and small breed dog when checking for neck pain, especially dogs less than 3-4 years of age. These breeds are at increased risk of congenital atlantoaxial (AA) instability. Flexing the neck in these patients can exacerbate the condition and may have devastating, potentially life-threatening, effects. You can almost always determine if a patient is painful by cervical palpation or range of motion of the neck dorsally and laterally.
In general, I don’t flex the neck of any toy or small breed dog unless I’m positive that the patient doesn’t have AA instability. I’ve diagnosed patients with congenital AA instability as old as eight years of age!
Cervical range of motion is also not recommended for trauma patients prior to obtaining cervical spinal radiographs to rule out fracture/luxation.
Author’s “pet peeve:” Note that I wrote flexion and extension of the neck above. By definition, cervical flexion is movement of the head/neck in a downward direction while extension is elevation of the head/neck. The term “ventroflexion” is redundant. But, worse still is using the term “dorsiflexion.” Flexion of the spine is NOT in a dorsal direction, so this term is incorrect. Dorsiflexion is a human medical term that means “the turning of the foot or the toes upward” by flexing the ankle.
