7.4: Cervical Spine - Special Tests Flashcards
PT places 1 hand under the chin and the other one the Occiput of the pt then slowly lifts the pt’s head
Distraction Test
Increased pain on distraction may be the result of
Muscle spasm, ligament sprain, muscle strain, dura irritability, or disc herniation
Compression test with 3 stages
Spurling’s Test
First stage of spurling
Compression of the head in neutral
Other name for spurling’s
Foraminal Compression Test
2nd stage of spurling
Compression with head in extension
Spurling’s Final stage
Compression with head in extension and rotation to the unaffected side
When to use spurling
when pt complains of radicular Sx
Provocative Tests for neurologic symptoms
Spurling’s
Jackson’s
Maximum Cervical Compression Test
Upper Limb Neurodynamic Test
Positive Sign for distraction test
pt’s Sx are relieved or decreased
positive sign for spurling’s
provocation of Sx
Symptoms radiates into the arm into which head is side flexed during compression
Spurling’s test may lead to Sx of what conditions?
Stenosis
Spondylosis
Osteophytes
Trophic, Arthritic, or Inflammed Facet Joints
Herniated Disc
Vertebral Fx
During spurling’s test, if pain or other symptoms is felt on the contralateral side of the head’s side bending direction, what is it called?
Reverse Spurling’s Sign
Reverse Spurling’s Sign is indicative of what?
Muscle Spasm in conditions such as:
Tension Myalgia
Whiplash Associated Disorders (WADs)
test where pt side flexes and rotates head to the same side
Maximum cervical compression test
In maximum cervical compression test, if the pain is felt on the concave side, it indicates what?
Nerve root or facet joint pathology
In maximum cervical compression test, if the pain is felt on the convex side, what does it indicate?
muscle strain
The position should be held for how long if using maximum cervical compression test for testing the artery
20-30 seconds
Modification of Spurling’s where pt rotates the head to one side then PT carefully presses straight down to the head
Jackson’s Compression Test
T/F: In the compression tests, dermatomal distribution of the Sx will not determine the nerve root involved
False
Test used for radicular symptoms, especially those involving the C4 or C5 nerve roots
Bakody’s/Shoulder Abduction (relief) test
Starting position of pt in Bakody’s
Sitting or Supine
How to do Bakody’s
PT passively or pt actively elevates the arm through abduction so that the hand/forearm rests on top of the head
Decrease of Sx in Bakody’s indicates what?
herniated disc
Epidural vein compression
Nerve root compression
All of which are usually in the C4-C5 or C5-C6 area
Abduction of the arm decreases the ______ of the neurological pathway and ______ on the lower nerve roots
Length of the neurological pathway and pressure on the lower nerve roots
Increase in pain during bakody indicates what?
Increasing pressure in the interscalene triangle
Special Test equivalent to the straight leg test in the lumbar spine
Upper Limb Neurodynamic (Tension) Test
Contraindications for ULNT?
cauda equina or spinal cord lesions
neurological signs are worsening or in the acute stage
Essential force to be applied on the shoulder during ULNT
Depression force
Why is depression force in ULNT essential?
so that even in abduction, the shoulder girdle remains depressed
if the shoulder is not held in depression, the tests are not likely to work
Position of ULNT 1
Shoulder - Depression and abduction (110 deg)
Elbow - extension
forearm - supination
wrist - extension
fingers - extension
cervical spine - contralateral side flexion
Position of ULNT 2
Shoulder - depression, abduction (10*), and ER
Elbow - extension
forearm - supination
wrist - extension
fingers - extension
cervical spine - contralateral side flexion
Position of ULNT 3
Shoulder - depression, abduction (110*), and IR
elbow - extension
forearm - pronation
wrist - flexion and ulnar deviation
fingers - flexion
cervical spine - contralateral side flexion
Position of ULNT 4
Shoulder - depression, abduction (10 to 90 deg), and ER
Elbow - flexion
Forearm - supination or pronation
Wrist - extension and radial deviation
Fingers - extension
Cervical Spine - contralateral side flexion
What is tested in ULNT 4
Ulnar nerve, C8 and T1 nerve roots
What is tested in ULNT 3
Radial nerve
What is tested in ULNT 2
Median nerve, musculocutaneous nerve, axillary nerve
What is tested in ULNT 1
Median nerve, anterior interosseous nerve, and C5, C6, C7 nerve roots
Normal sensations in ULNT
Deep ache/stretch in the cubital fossa (99%)
Deep ache/stretch into anterior and radial aspect of forearm and radial aspect of hand (80%)
Tingling to the fingers supplied by the appropriate nerve (nerve bias)
Stretch in the anterior shoulder
Above responses increased with contralateral cervical side flexion and decreased with ipsilateral cervical side flexion
Positive indications for ULNT
Production of pt’s Sx (most important)
A sensitizing test in the ipsilateral quadrant alters the Sx
Different Sx between right and left (contralateral quadrant)
Modification of the ULNT
brachial plexus tension test
procedure for brachial plexus tension test
Sitting pt abducts arms c elbow extended, stopping at the onset of Sx
Then PT holds this position while pt flexes their elbows so that the hands lie behind their head
What is stressed in the brachial plexus tension test
Primarily the Ulnar nerve, and C8-T1 nerve roots (Similar to ULNT4)
Test used to determine the effect of increased pressure in the spinal cord
Valsalva Test
Maneuver for Valsalva Test
Pt is asked to take a deep breath while bearing down (as if moving the bowels)
Positive indication for valsalva test
increased pain that may be caused by increased intrathecal pressure
what are possible causes of a positive valsalva test
space-occupying lesions such as herniated discs, tumors, stenosis, or osteophyte formations
Why should the valsalva test be done with caution
Pt may become dizzy and pass out during or shortly afterward the test if the procedure blocks the brain’s blood supply
What is romberg test used for
upper motor lesion
Procedure for romberg test
pt is in standing and is asked to close the eyes for 20-30 seconds
positive indication for romberg
pt’s body sways excessively or pt loses balance
T/F: Vertebral Artery (Cervical Quadrant) Test and the special test for VBI have the same procedure
True
Procedure for Vertebral artery (cervical quadrant) test
pt is in supine while PT passively takes pt’s head and neck into extension and side flexion
PT then rotates the neck to the same side as the side flexion and holds position for approx. 30 sec
Positive indication for Vertebral artery (cervical quadrant) test
Provoking sx if the opposite artery is affected
dizziness and nystagmus indicates compression of the vertebral artery
Tests for cervical instability
Sharp-Purser
Transverse (lateral) shear test
Lateral flexion alar ligament stress test
Rotational alar ligament stress test
Transverse ligament stress test
Procedure for lateral flexion alar ligament stress test
Pt lies in supine c head in the neutral position > PT stabilizes the axis c a pinch grip around the spinous process & lamina > PT attempts to side flex the head and axis
What is to be expected during lateral flexion alar ligament stress test for normal individuals
Minimal side flexion with a strong capsular endfeel and a solid stop
Procedure for Lateral (transverse) shear test
Pt lies in supine c head supported > PT places their 2nd MCP joint of one hand against the transverse process of the atlas and the 2nd MCP of the other hand over the opposite transverse process of the axis > PT’s MCPs are then pushed together causing shear of one bone on the other
What is to be expected during the lateral shear test for normal individuals
Minimal motion and no Sx
Pain is a normal sensation d/t the compression of the soft tissues against the bone
Why is lateral shear test used
to determine the instability of the atlantoaxial articulation caused by odontoid dysplasia
T/F: The lateral shear test can also be used to test the other cervical spine levels
True
Procedure for the rotational alar ligament stress test
Pt is in sitting > PT grips lamina and spinous process of C2 between their finger and thumb > PT then passively rotates the head left or right moving to the “no Sx” side first while stabilizing C2
Positive indication for Rotational Alar Ligament Stress Test
More than 20 to 30 degrees of rotation without C2 moving
What does a positive Rotational Alar Ligament Stress test indicate?
injury to the contralateral alar ligament especially if the lateral flexion stress test is positive in the same direction
What does excess motion in Rotational Alar Ligament and Lateral Flexion Alar Ligament Stress Test indicate
instability is due to an increase in the neutral zone in the joint
Why is Sharp-Purser Test done
to determine sublaxation of the atlas on the axis
What will happen if the transverse ligament that maintains the position of the Odontoid process on the C1 is torn
C1 will translate forward on C2 during flexion
procedure for Sharp-purser test
PT places one hand on pt’s forehead while the thumb of the other hand over the spinous process of C2 (first palpable spinous process after occiput) > ask pt to slowly flex the head while PT presses the head backward with the palm
Positive indication for Sharp-Purser test
PT feels the pt’s head sliding backward
What to do if PT feels the pt’s head sliding backward during Sharp-Purses
IMMEDIATELY STOP
Tests for Thoracic Outlet Syndrome
Adson’s
Military Brace (Costoclavicular Syndrome) test
Wright test
Procedure for Wright test
Pt’s arm is hyperabducted so that the hand is brought over the head c elbow and arm in the coronal plane c shoulder in ER
Positive indications for the TOS special tests
Disappearing Radial Pulse
Procedure for Adson’s
PT palpates for the radial pulse > pt’s head rotates to the side that is tested > pt then extends the head & PT puts the shoulder into extension and ER > pt is asked to take a deep breath
Procedure for Military Brace/Costoclavicular Syndrome Test
PT palpates the radial pulse then draws the pt’s shoulder down and back
