2.3 Cervical Spine Special Tests Flashcards
SPECIAL TESTS For Neurological Sx
Foraminal Compression (Spurling’s) Test
Maximum Cervical Compression Test
Jackson’s Compression Test
Distraction Test
Bakody’s Test (C4-C5 affectation)
Upper Limb Tension Test / Elvey Test
T OR F: Tests for Neurological Symptoms are designed to provoke neurological symptoms in most cases, but they do not necessarily tell where the pathology is originating.
TRUE
Tests for neurological symptoms that involve movement of the nerve
neurodynamic tests
assess the sensitivity of nerve roots and peripheral nerves to movement and tension caused by the movement
Pt bends or side flexes the head to the unaffected side first, then the affected
side & PT carefully presses straight down the head
Foraminal Compression (Spurling’s) Test
3 stages of Spurling’s Test
Head in neutral
Head in extension
Head in ext and rotation
Foraminal Compression (Spurling’s) Test may indicate what?
cervical radiculitis
implies pain in the dermatomal distribution
of the nerve root affected
Radiculitis
if the pain is felt in the opposite side during Spurling’s Test
Reverse Spurling’s Sign
Pt side flexes the head and rotates it to the same side
Maximum Cervical Compression Test
In Maximum Cervical Compression Test, pain on the concave side indicates _____ (2), whereas pain on the convex side indicates _____ (1)
nerve root or facet joint pathology
muscle strain
How many seconds should the Maximum Cervical Compression Test (c extension) to elicit VBI?
20-30 seconds
Modification of the foraminal compression test where Pt rotates the head to one side and PT then carefully presses straight down the head
Jackson’s Compression Test
used for patients who have complained of radicular symptoms in the history and show radicular signs during the examination
Distraction Test
In distraction test, PT places 1 hand under ___ with the other around the ____
pt’s chin; occiput
What indicates a (+) distraction test?
Pain is relieved or decreased when head is lifted;
Indicates relief of pressure pressing on the nerve roots
used to test for radicular symptoms, especially those involving the C4 or C5 nerve roots
Shoulder Abduction (Relief) Test/Bakody’s Sign
patient is sitting or lying down, and the examiner passively or the patient actively elevates the arm through abduction so that the hand or forearm rests on top of the head
Shoulder Abduction (Relief) Test/Bakody’s Sign
What indicates a (+) Bakody’s Sign?
decrease in or relief of symptoms
may indicate a cervical extradural compression problem, such as a herniated disc, epidural vein compression, or nerve root compression, usually in the C4–C5 or C5–C6 area
In Bakody’s sign, abduction of the arm _______ the length of the neurological pathway and ______ the pressure on the lower nerve roots? (increases or decreases)
decreases the length
decreases the pressure
T OR F: In Bakody’s Sign, if the pain increases with the positioning of the arm, it implies that pressure is increasing in the brachial plexus.
FALSE
it implies that pressure is increasing in the INTERSCALENE TRIANGLE.
equivalent to the straight leg raising (SLR) test in the lumbar spine
Upper Limb Neurodynamic Tension Tests (ULNT) / Brachial Plexus Tension or Elvey Test
T OR F: Modification of the position of the shoulder, elbow, forearm, wrist, and fingers places greater stress on specific nerves (nerve bias).
TRUE
ULNT 1 nerve bias
Median nerve, anterior interosseous nerve, C5, C6, C7
ULNT 2 nerve bias
Median nerve, musculocutaneous nerve, axillary nerve
ULNT 3 nerve bias
Radial nerve
ULNT 4 nerve bias
Ulnar nerve, C8 and T1
Special Tests for Instability
SALT
Sharp-Purser Test
Alar Ligament Stress Test
Transverse Ligament Stress Test
Lateral Shear Test
Sharp-Purser Test is a test to determine subluxation/forward translation of the ___ on the ____?
ATLAS (C1) on AXIS (C2)
What is used for atlanto-axial instability?
Sharp-Purser Test
Sharp-Purser Test
PT places one hand on forehead, and one on ____
Pt flexes the head while PT applies _____ pressure on forehead
spinous process of C2
posterior pressure
What indicates a (+) Sharper-Purser Test?
(+) sliding back of the head (subluxation of the atlas has been reduced)
may be accompanied by a clunk
In Transverse Ligament Stress Test, Pt lies in supine with the PT supporting the pt’s occiput with their palm and _____ fingers
3rd to 5th fingers
In Transverse Ligament Stress Test, PT places their index fingers where?
in the space between the pt’s occiput and C2’s
spinous process
done in order for the PT’s fingers to overlie the neural arch of C1
T OR F: In Transverse Ligament Stress Test, head and C1 are then carefully lifted anteriorly together, allowing no flexion or extension
TRUE
how many seconds do you hold the anterior shear in the Transverse Ligament Stress Test?
10-20 seconds
(+) Transverse Ligament Stress Test indicates?
hypermobility at the atlantoaxial articulation
Determine the instability of the atlantoaxial articulation caused by odontoid dysplasia
Lateral (Transverse) Shear Test
In lateral shear test, PT places the ___ MCP joint of one of their hands against the transverse process of the _____ and the MCP joint of their other hand against the opposite transverse process of the _____
2ND MCP joint one of their hands against the transverse process of the ATLAS
against the opposite transverse process of AXIS
T OR F: Pain on the affected is an indication of a (+) lateral shear test
FALSE
Pain is normal d/t compression of soft tissues against the bone
(+) Lateral shear test = Increased motion or production of spinal cord/vascular symptoms
In Lateral Flexion Alar Ligament Stress Test, PT stabilize the ____ with a ____ grip around the _____ (2).
PT stabilize the AXIS/C2 with a WIDE PINCH grip around the SPINOUS PROCESS and LAMINA
T OR F: Lateral Flexion Alar Ligament Stress Test is an active test.
FALSE
Lateral Flexion Alar Ligament Stress Test is PASSIVE test with the PT passively side flexing the head & axis
What test?
PT grips the lamina and spinous process of C2 between the finger and thumb
While stabilizing the C2, PT passively rotates the head left or right moving to the no symptom side first
Rotational Alar Ligament Stress Test
What is considered (+) Rotational Alar Ligament Stress Test?
More than 20 to 30 degrees rotation without the C2 moving
Indicative of injury to the contralateral alar ligament especially if the lateral flexion alar ligament stress test is positive in the same direction
What is the position of the patient’s head & neck in verterbral artery/cervical quadrant test?
extension, side flexion, rotation to same side then hold for 30 seconds
What is considered (+) verterbral artery/cervical quadrant test?
Provokes referring symptoms if the OPPOSITE side artery is affected
