Cervical Flashcards
What does Spurlings
Local strain/sprain, Jt damage, facet irritation, cervical subluxation
Spurlings techniques
Rest elbows on shoulders
Apply force down
R + slight SB (don’t continue if pain)
+ E to unaffected side + comp
+ E to affected side + comp
+ve test for Spurlings
Radicular P and/or altered sensation in dermatomal distribution
Local neck pain- not +ve
Indicative of local sprain/strain, Jt damage, facet lock, mensicoid entrapment, cervical subluxation
Specificity of Spurlings
92%
Sensitivity of Spurlings
77%
What does Jacksons compression test for
Increased pressure on nerve roots, DJD, osteophytes, radiculopathy
Technique of Jacksons test
Pt rotate head to one side
Apply force down on head
Repeat with head rotated to other side
+ve Jacksons test
Peripheral P and/or altered sensation (radiation down arm- dermatomal)
What does distraction test for
Muscle, ligament, or capsule
Increased pressure on nerve roots
Facet irritation, DJD
Distraction technique
Cup chin, support occiput Lift head
+ve test for distraction
Inc local P- muscle, lig, Jt capsule damage
Dec peripheral P/numbness- decreased pressure on nerve root (relief)
Dec local P- facet impingmenet, DJD
-ve test for distraction
P, muscle spasm, ligament strain, muscle strain, Dura irritability, disc herniation
Lateral stability stress test of atlanto-axial Jt
Pt supine
Support occiput and left side of arch of atlas
= Lateral shear of atlas and occiput on axis to the right
Repeat on the other side
Excessive movement, and reproduction of symptoms suggests lateral instability of this Jt
Anterior translation stress of atlas on axis
- Pt supine
- Fix C2
- Using thumb pressure over ant aspects of TP, lift head and atlas vertically
Csp instability clearing Qs
- H/As?
- Feeling like you need to hold your head up?
- Reluctance to move head?
- 5Ds, 3Ns, A
Improved neck exam
Palpation- bumps which are not tender indicate long term injury
Tenderness= inc inflammation/recent injury (fibrosis)- thickening/scarring of tissue
AROM- hold to allow tissue to relax
PROM neck
o Flx- C2/3- just roll head (double chin). C3 onwards= normal. Look for deviation to either side
o Ext- relative to Flx
o SB- Go between sides, and palpate articular pillar/post-lat masses. C2/3 is slight. C3 onwards aplly slight Flx to counteract spinal mechanics
o Rot- pivot hand
Adsons test
Vascular TOS
Abduct arm 30, maximally extend
See if radial pulse diminshes
Lacks inter-rater reliability
Bikeles
Neurogenic TOS
Active test to bring on P+Ns
Wrap fingers round neck, full extension
Tagrtes median nerve
When symptoms felt, bring ear to shoulder- ask if there are any changes (should reduce P)
Not very useful as TOS mainly affects ulnar nerve
+ve Bikeles
Reproduction of radicular symptoms –> N root tension, brachial plexitis, possibly meningitis
Radial N test
Hand by side
Upper side of palm facing floor
Ulnar N
Same as bikeles but palm faces up not around neck
Brudzinskis sign set up
Pt supine with legs straight, examiner flexes Pts head and neck
Brudzinskis interpretation
Involuntary hip and knee flexion –> meningeal irritation/inflammation (meningitis)
L’Hermittes sign
Pt may be seated or supine
Pts head is passively flexed forward
Examiner may apply gentle pressure
Essential PROM with slight pressure
L’Hermittes interpretation
Reproduction of radicular symptoms (sharp, shooting down spine or extremities) –> cervical radiculopathy
Vertebralbasilar artery function test
Pt seated, eyes open, examiner does the following:
1. Observation for carotid or subclavian pulsations
2. Auscultations for bruits
3. Palpation with Pt rot and Ext head (bilaterally)
Vertebralbasilar artery function test interpretation
+ve Pulsations, bruits, pre-syncope, vertigo, nystagmus, and/or nausea–> VBI VB Insufficiency)
VBI Test
Pt supine or seated, examiner supports head and follows 3 steps:
1. SB of Pts neck
2. Rot of neck to same side
3. Ext of neck- then ask Pt to look at a fixed point on the ceiling- the position may be held for up to 30s and ask Pt to count backwards from 10
VBI test interpretation
Pre-syncope, nystagmus, vertigo, slurred speech, visual changes and/or nausea–> VBI, cervicogenic vertigo, cervical instability w brainstem compression
Tingling or electrical arm P–> nerve root compression
VBI test- clinical notes
Eyes must be open for nystagmus
Use prior to mobilisation or manipulation
