Cervical and thoracic Lab

Question 1

Quick clear for UE conditions

Answer 1

• SPurling’s test
• central and unilateral PA’s
• upper limb neurodynamics tension test (median nerve)

Question 2

upper cervical flexion

Answer 2

Purpose: to assess active mobility of upper cervical vertebrae, specifically flexion

-Patient is seated at the edge of the plinth. have patient pull chin straight back while keeping their eyes level, and teeth together. therapist adds a posterior force at the chin with one hand and an anterior/superior force near posterior occiput. then with OP.

Question 3

upper cervical extension

Answer 3

Purpose: to assess active mobility of upper cervical vertebrae, specifically extension
- Patient is seated at the edge of the olinth. have patient jut their chin straight out anteriorly while keeping their eyes level, keeping teeth together. therapist will then add a superior force from just underneath the chin with one hand while adding an inferior force near posterior occiput. then OP

Question 4

Upper cervical Quadrant

Answer 4

Purpose: to assess active mobility of upper cervical vertebrae
- Patient is seated at edge of plinth. instruct patient to jut chin forward. Rotate head toward right side. side bend head toward right side. with their hand around each ear, the PT will then add OP into upper cervical extension, rotation, and side bending directions simultaneously. OP

Question 5

Flexion-Rotation test

Answer 5

Purpose: to assess passive mobility of upper cervical rotation ROM
-patient is supine on plinth with pillow under knees. Cradle patient’s head in your hands, with patient’s ears in the webspace of each thumb. with the patient relaxed, flex patient’s head up, then rotate patient’s nose toward their R shoulder. assess end feel and change in symptoms. slowly return head to neutral

normal: 45 deg. (+) <33deg in cervicogenic headache patients

Question 6

Palpation of suboccipital extensors

Answer 6

Purpose: to assess the suboccipital extensor muscles. assessing whether they are hypertonic, leathery, or atrophied. comparing sides is also important
-Patient is supine with head resting at the edge of table. cradle patient’s head in your hands, with tips of fingers palpating in the suboccipital region. assess for tissue tonicity, restrictions and symptoms reproduction. this can be used as a STM

Question 7

extension- Retraction

Answer 7

Purpose: to assess passive mobility of cervical retraction ROM
-patient is supine on plinth with head off end of plinth, supported by therapist. cradle patient’s head in one heand at occiput, with other hand on patient’s forehead. with the patient relaxed, retract patient’s head by dropping hand on occiput posteriorly and pushing forehead posteriorly

Question 8

OA nodding

Answer 8

Purpose: to assess passive mobility of OA nodding ROM
-patient is supine on plinth. cradled patient’s head in your hands, with patient’s ears in the wbspace of each thumb. with the patient relaxed, move patient’s head in a slight nodding motion from the OA articulation

Question 9

OA side glide

Answer 9

Purpose: to assess passive mobility of OA side glide ROM
-patient is supine on plinth. cradle patient’s head in your hands, with patient’s ears in the webspace of each thumb. with the patient relaxed, move patient’ head in a slight side bending motion from the OA articulation

Question 10

C1 side glides

Answer 10

Purpose: assess ROM in the frontal plane or improving segmental ROM
-patient is supine on plinth, head off plinth. support top of head with abdomen. cradle patients head in hands. palpate the mastoid process behind patient’s ears, then slide fingers just distally, onto transverse process of C1. Index and middle finger pads apply a sideglide force.

Question 11

palpation of arch of C1

Answer 11

Purpose: palpate for stiffness or reproduction of pain
- patient is positioned in the prone position. therapist palpates the occiput and moves just inferior onto the arch of C1. therapist palpates along the arch looking for reproduction of patient’s pain

Question 12

palpation of transverse process of C1

Answer 12

Purpose: assessing symptoms
- therapist palpates the angle of the mandible. therapist then palpates the mastoid process. examiner moves down along the angle of the mandible and along the anterior surface of the SCM. The first hard bony structure found s the transverse process of C1

Question 13

Side Glide

Answer 13

Purpose: assess facet joint accessory motion
-Patient is positioned in supine. therapist palpates the spinous process at the level of involvement. therapist then moves lateral to the spinous process to find the involved facet joint. Using the lateral aspect of the 2nd middle phalanx applies a lateral glide to the facet. (+) test is reproduction of symptoms, hypomobility, or hypermobility.

Question 14

contract relax for side glides

Answer 14

Purpose: To improve accessory mobility of cervical facet joints
1. Patient is positioned in supine. Resting symptoms are assessed. 2. Therapist palpates the spinous process at the level of involvement. 3. Therapist then moves lateral to the spinous process to find the involved facet joint. 4. Using the lateral aspect of the 2nd middle phalanx applies a lateral glide to the facet to the barrier. 5. Keeping glide on with R hand, place L hand on side of patient’s head. 6. Ask patient to meet your resistance with your L hand. Hold 7 seconds. 7. Have patient relax and side glide further into new range.

Question 15

upglides

Answer 15

Purpose: To assess how the facet joints are opening
1. Patient is positioned in the supine position. Resting symptoms are assessed. 2. Therapist palpate the spinous process at the level of involvement 3. Therapist then moves lateral to the spinous process to find the involved facet joint 4. Examiner applies a force at the involved facet towards the opposite eye 5. Positive if there is a reproduction of pain, hypomobility, or hypermobility

Question 16

down glides

Answer 16

Purpose: To assess how the facet joints are closing down
1. Patient is positioned in the supine position. Resting symptoms are assessed. 2. Therapist palpate the spinous process at the level of involvement 3. Therapist then moves lateral to the spinous process to find the involved transverse process 4. Examiner applies a force at the involved transverse towards the opposite shoulder 5. Positive if there is a decrease in pain, hypomobility, or hypermobility

Question 17

Sharp Purser’s Test

Answer 17

Purpose: To assess upper cervical instability
1. Patient is seated with neck in semiflexed position. Resting symptoms are assessed. 2. Place palm of one hand on patient’s forehead or hug the patient’s head, and index finger and thumb of other hand on spinous process of axis. 3. Apply a posterior translation through the forehead. 4. Assess stability of atlantoaxial joint. 5. (+) test is reproduction of myelopathic symptoms during forward flexion or decrease in symptoms during anterior to posterior movement or excess displacement during the AP movement. 6. Refer out for radiograph and stabilization.

Question 18

Alar ligament test

Answer 18

Purpose: To assess upper cervical instability
1. Patient is supine on plinth, head in neutral. 2. Stabilize C2 by grabbing spinous process and lamina with fingers. 3. Side bend patient’s head to R side and feel for L transverse process to come into fingers. 4. Assess end feel. 5. Return head too neutral. 6. Repeat to L side. 7. (+) test is significant side bending with empty end feel, and transverse process does not come into fingers with side bending.

Question 19

VBI (vetebrobasilar artery insufficiency test)

Answer 19

Purpose: To assess vertebral basilar artery insufficiency
1. Patient is sitting, neutral spine 2. Ask patient to lean forward, with their elbows on their knees, and place their head in their hands (cervical extension) 3. Remain in that position for 15 seconds. 4. Assess reproduction of symptoms. 5. Return too neutral for 15 seconds to assess for latent symptoms 6. From that position, ask patient to return to elbows on knees and turn their head to the R, keeping cervical extension. 7. Remain in that position for 15 seconds. 8. Assess reproduction of symptoms. 9. Return too neutral, and assess for 15 seconds 10. Repeat to on L side. 11. Remain in that position for 15 seconds. 12. Assess reproduction of symptoms. 13. (+) test is reproduction of nystagmus, nausea, numbness/tingling faintness, 5 D’s (dizziness, dysarthria, dysphagia, diplopia, drop attack)

Question 20

Cervicogenic Vertigo Differentiation

Answer 20

Purpose: To differentiate cervicogenic vertigo symptoms from positional vertigo
1. Patient is standing with neutral spine. Resting symptoms are assessed. 2. Hold patient’s head in your hands, with patient’s ears in the webspace of each thumb. 3. Ask patient to step and rotate their body to the right while you hold their head facing forward. 4. Hold position for up to 1 minute and assess symptoms. 5. Ask patient to return too neutral. 6. Assess to left side. 7. (+) test is reproduction of cervicogenic symptoms.

Question 21

SPecial tests for cervical rediculopathy

Answer 21

1. Bakody’s Sign/Shoulder Abduction Test
2. Spurling’s Compression Test
3. Neck Distraction Test
4. Upper Limb Neurodynamic Testing

Question 22

Bakody’s Sign or Shoulder Abduction Test

Answer 22

Purpose: To assess upper limb neurodynamic symptoms
1. Patient is seated, arms at sides. 2. Therapist assesses resting symptoms. 3. Ask patient to actively place arm on top of his head. 4. Assess change in symptoms. 5. (+) test is reduction of arm pain.

Question 23

SPurling’s compression test

Answer 23

Purpose: To assess reproduction of cervical radiculopathy symptoms
1. Patient is seated, with head slightly side bent to the test side. 2. Interlock fingers over the top of patient’s head. 3. Apply 7kg of pressure in a downward through the top of the patient’s head. 4. (+) is reproduction of symptoms.

Question 24

neck distraction test

Answer 24

Purpose: To assess relief of cervical radiculopathy symptoms
1. Patient is seated, neutral spine. Assess resting symptoms. 2. Grasp patient’s head with thenar eminences under occipital protuberance. 3. Apply distraction force through occipital protuberance. 4. Assess for change in symptoms 5. (+) test is reduction of symptoms

Question 25

Median nerve General screen

Answer 25

Purpose: Assess neurodynamic mobility and sensitivity
1. Cervical spine neutral 2. Shoulder girdle depression 3. GH Abd to 110 deg 4. Wrist finger extension with supination of forearm 5. GH external rotation 6. Elbow extension 7. Cervical side bending 8. *need to assess start symptoms, ask for changes as each component is added, ask for THE symptoms, should be done to the uninvolved side first!

Question 26

Radial nerve

Answer 26

1. Therapist stands at side of table facing the patient’s feet 2. Patient supine and laying diagonally across table 3. Arm is 10 degrees abducted 4. Elbow starts flexed 5. Gentle depression of shoulder with therapist’s hip 6. Depression is maintained and elbow is extended 7. Shoulder if internally rotated 8. Forearm is pronated 9. Keep all the components locked 10. Wrist is flexed with thumb in fist 11. Wrist is ulnarly deviated 12. Release of shoulder girdle depression to implicate dural tightness

Question 27

Ulnar nerve

Answer 27

1. Scapular depression 2. Shoulder ER 3. Shoulder Abduction to 90° 4. Elbow flexion to 90° 5. Forearm pronation 6. Wrist extension/Finger Extension (especially digits 4 and 5) 7. Elbow flexion until symptoms are reproduced

Question 28

Deep neck Flexor muscle endurance test

Answer 28

Purpose: assess DNF muscle endurance
1. Patient is supine on plinth. 2. Position patient’s head in full retraction. 3. Flex patient’s head about 2.5 cm off the plinth and ask patient to hold position. 4. Therapist places hand under head to detect change in position, and observe skin folds on patient’s neck. 5. (+) test is patient is unable to hold position for Men: 38.9 seconds, Women: 29.4 seconds as evidenced by head dropping or skin folds lessening.

Question 29

Craniocervical flexion test

Answer 29

Purpose: DNF coordination
1. Patient nods their chin down and then lifts their head off table 2. Therapist assesses quality of motion and muscle activation 3. Biofeedback cuff is then used under the neck pumped up to 20 mm Hg 4. Patient nods their head “yes” trying to move to 22 mm Hg 5. Patient holds for 10 seconds 6. Patient then relaxes for 10 seconds 7. Patient performs again then moves to again to 24 mm Hg 8. Patient repeats the cycle increasing in increments of two until reaching 30 mm Hg 9. Patient can place their tongue on the roof of their mouth in an N position to help limit superficial muscles while they hold this position

Normal - If patient can hold for 10 seconds at each level up to 30 mm Hg

Abnormal - Patient is unable to get to 30 mm Hg with a hold of 10 seconds - Patient is unable to hold for 10 seconds - Patient demonstrates poor quality of motion and chin juts forward or uses excessive superficial cervical flexors such as sternocleidomastoid or scalenes

Question 30

deep neck extensor coordination assesment

Answer 30

Purpose to assess deep neck extensor strength, endurance and coordination
: 1. Ask patient to “Lift up your head”
2. Observe the preferred movement pattern, does the patient demonstrate the following faulty patterns? - initiates this motion with craniocervical extension? - excessively extend at 1 area of the spine with significant creasing of the skin - experience reproduction of their symptoms
3. Correct the movement with the following cue: “Lift your head while keeping your eyes on a spot/object (like a book or a phone) here right between your hands. Do not let your eyes leave this spot.” 4. This should maintain the upper cervical spine in neutral as they lift their head 5. Reassess patient’s movement with this cue and ask if the symptoms have changed. 6. Have the patient repeat this movement 5-10 times 7. The patient fails the test if: - They lift the head with excessive upper cervical extension - They cannot get to the full head lift in the upper cervical neutral position - They cannot complete 5 to 10 repetitions with smooth, controlled movement 8. This movement can be used to improve deep neck extensor coordination, strength and endurance by repeating multiple repetitions

Question 31

Cervical Extensor Endurance Test

Answer 31

Purpose to assess the endurance of the deep cervical extensors
1. Place the head in neutral and stabilize the cervicothoracic junction 2. Encourage patient to hold this position for up to 20 seconds 3. Test is positive if: - Head drops into a head forward position - The upper cervical spine extends 5-10 degrees

Question 32

Cervical SNAG

Answer 32

Purpose: To decrease pain and improve segmental mobility
1. Patient is sitting in neutral spine 2. Therapist places right thumb on segment on the side of pain 3. Therapist then places left thumb on top of right thumb 4. Thumbs are used to provide traction by applying an upglide 5. The patient then rotates to the opposite side (can also do this with side bending) 6. As the patient is rotating to the opposite side, the glide is maintained 7. The patient then rotates back to neutral 8. The glide is maintained until the patient is in neutral 9. Release glide and repeat

Question 33

Cervical segmental Contract relax

Answer 33

Purpose: increase ROM in restricted plane
1. Therapist cradles patients head in hands 2. Therapist then palpates restricted segments 3. Examiner side glides patient to limit of range on restricted side (limited right side bending, you will side glide to the left to the limitation, creating right side bend) 4. Patient is asked to side bend to towards the contralateral side (left side bend in this example) and hold position for 7 seconds (contract the left side benders) 5. Patient is then asked to relax 6. Therapist moves patient’s head back to restricted side (right side bending in this example) to take up newly created slack 7. The stretch is held at end range for few seconds 8. Repeat cycle

Question 34

Upper Cervical (C1-C2) Contract Relax

Answer 34

Purpose: To increase upper cervical rotation
1. Lift the patient’s head up to a fully flexed position 2. Rotate the patient to the side that he/she is limited in to his/her barrier 3. Have patient contract head into the opposite side rotation of where he/she is limited into your hand 4. Patient contracts for 7 seconds 5. Patient relaxes 6. Bring patient into further rotation to limited side 7. Repeat steps 2-6

Question 35

Contract Relax of Suboccipital Extensors

Answer 35

Purpose: To stretch out tight suboccipital extensors and increase upper cervical flexion
1. Ask the patient to look up towards you to activate the suboccipital extensors 2. Hold this for 7 seconds 3. Ask the patient to relax again taking the patient into passive upper cervical retraction flexion for 30 seconds

Question 36

O-C1 Longitudinal Distraction

Answer 36

Purpose: Improve mobility at the O-C1 joint
1. Patient is positioned in supine position. Resting symptoms assessed. 2. Therapist rotates the head slightly to get a good purchase on the occiput 3. Therapist uses the head of their second metacarpal against the occiput on the side they are trying to distract 4. The examiner then hugs the head with the other arm, covering the chin without placing finger over the patient’s throat 5. A traction force is applied

Question 37

Supine Flexion Manipulation

Answer 37

Purpose: General distraction force to mobilize T/S to treat mechanical C/S pain (CPR
1. Patient is asked to cross arms with contra-lateral side over another to allow T/S to slightly flexed and open the contra-lateral side 2. Place towel-roll under the patient’s arms and over his/her chest to create a wedge 3. Roll patient over to therapist side, as the patient is placed in a flexed & side-bend position 4. Locate segment to be mobilized 5. Utilizing the “pistol grip” and place hand grip onto the T/S segment with a radial deviation 6. Therapist bring wrist into neutral as patient is rolled back onto supine position 7. Therapist place sternum onto patient’s arms; creating a perpendicular angle to the segment being treated 8. Secure patient’s C/S and place patient into flexion and side-bend to therapist’s side 9. Have patient take a deep breath in 10. On end of exhalation, therapist create an anterior-posterior thrust on the T/S segment by dropping the body weight through the sternum

Question 38

Prone Extension Manipulation

Answer 38

Purpose: To increase mobility
1. Stand on the ground or a stool to be positioned above the patient. 2. Palpate the thoracic spine until the desired segment is found. 3. If standing on the left side of the patient use the left hand to line up the pisiform on to the left facet 2 segments above the desired to take up tissue slack. 4. Line up the right hand along with the left, and twist so that the pisiform on the right hand will be next to that of the left. The two hands should make a right angle with each other. 5. Instruct the patient to take in a deep breath, and while they exhale, slowly lower your body weight to take up slack. When the patient has reached the end of their exhalation, apply a quick thrust through the hands to the desired segment.

Question 39

Flexion with overpressure

Answer 39

Purpose: To assess thoracic spine flexion mobility
1. Patient is seated at edge of plinth. Resting symptoms assessed. 2. Instruct patient to bend forward, bringing their elbows toward their knees. 3. Assess change in symptoms, then ask patient to return to neutral. 4. Take patient passively into flexion and add overpressure by pressing down on elbows. 5. Assess change in symptoms, then return patient to neutral.

Question 40

extension with OP

Answer 40

1. Patient is seated at edge of plinth. Resting symptoms assessed. 2. Instruct patient to look up toward the ceiling. 3. Assess change in symptoms, then ask patient to return to neutral. 4. Take patient passively into extension and add overpressure by lifting elbows. 5. Assess change in symptoms, then return patient to neutral.

Question 41

side bending with OP

Answer 41

1. Patient is seated at edge of plinth. Resting symptoms assessed. 2. Instruct patient to sidebend, bringing their right elbow toward their right hip. 3. Assess change in symptoms, then ask patient to return to neutral. 4. Ask patient to cross their arms over their chest and take patient passively into right sidebending; add overpressure through the shoulders. 5. Assess change in symptoms, then return patient to neutral. 6. Repeat on the left side.

Question 42

Rotation w/ OP

Answer 42

1. Patient is seated at edge of plinth. Resting symptoms assessed. 2. Instruct patient to sidebend, bringing their right elbow toward their right hip. 3. Assess change in symptoms, then ask patient to return to neutral. 4. Ask patient to cross their arms over their chest and take patient passively into right sidebending; add overpressure through the shoulders. 5. Assess change in symptoms, then return patient to neutral. 6. Repeat on the left side.

Question 43

Quadrant w/ OP

Answer 43

1. Patient is seated at edge of plinth. Resting symptoms assessed. 2. Instruct patient to rotate right, sidebend right and extend. 3. Assess change in symptoms, then ask patient to return to neutral. 4. Take patient into right rotation, sidebending, and extension adding overpressure through the shoulders. 5. Assess change in symptoms, then return patient to neutral. 6. Repeat on the left side.

Question 44

Upper Thoracic Spine - Flexion

Answer 44

1. Patient is seated at edge of plinth. Resting symptoms are assessed. 2. Palpate T1 spinous process. 3. Passively flex patient’s head and neck. 4. Palpate interspinous spaces.

Question 45

Upper thoracic Spine- extension

Answer 45

1. Patient is seated at edge of plinth. Resting symptoms are assessed. 2. Palpate T1 spinous process. 3. Passively extend patient’s head and neck. 4. Palpate interspinous spaces.

Question 46

Rib cage mobility

Answer 46

Patient is standing with neutral spine. 2. Place hands over clavicles with thumbs touching over manubrium. 3. Ask patient to take a deep breath in, then relax. 4. Assess mobility and symmetry of upper ribs using thumbs as a guide. 5. Move hands lower to about T6 level, starting laterally, and bring thumbs together at xyphoid process. 6. Ask patient to take a deep breath in, then relax. 7. Assess mobility and symmetry of middle ribs using thumbs as a guide. 8. Move behind patient and place hands on lower ribs, starting laterally, and bring thumbs together at T10. 9. Ask patient to take a deep breath in, then relax. 10.Assess mobility and symmetry of lower ribs using thumbs as a guide.

Question 47

First rib mobility

Answer 47

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Palpate 1st rib posterior to clavicle using 2nd metacarpal head. 3. Assess change in symptoms and mobility compared to opposite site.

Question 48

First rib spring test

Answer 48

1. Patient is supine on plinth. Resting symptoms are assessed. 2. Using thumb press inferiorly in supraclavicular space. 3. Assess for symmetry and position. 4. (+) test = elevated first rib unilaterally

Question 49

Cervical rotation lateral flexion test

Answer 49

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Passively rotate the patient’s head away from affected side. 3. Passively sidebend head ear to chest 4. Assess range of motion loss and change in symptoms. 5. (+) test = limited range of motion, possibly hard or firm end feel that is different from opposite side.

Question 50

1. Costochondral joint palpation

Answer 50

1. Patient is supine on plinth. Resting symptoms are assessed. 2. Palpate costochondral joints. 3. Assess for change in symptoms. 4. (+) test = pain with palpation, stiffness or asymmetry

Question 51

Sternocostal joint palpation

Answer 51

1. Patient is supine on plinth. Resting symptoms are assessed. 2. Palpate sternocostal joints. 3. Assess for change in symptoms. 4. (+) test = pain with palpation, stiffness or asymmetry

Question 52

Rib angle palpation

Answer 52

1. Patient is prone on plinth. Resting symptoms are assessed. 2. Palpate along medial scapular border for rib angle. 3. Assess rib position. 4. (+) test = rib held more posteriorly or anteriorly compared to other side.

Question 53

Heel Drop Test

Answer 53

Purpose: To assess for potential vertebral fracture
1. Patient is standing. Resting symptoms are assessed. 2. Ask patient to rise up on their toes, then drop down quickly. 3. Assess for change in symptoms, reproduction of pain. 4. If positive, refer out for X-Ray.

Question 54

Percussion

Answer 54

Purpose: To assess for potential vertebral fracture
1. Patient is standing. Resting symptoms are assessed. 2. Strike tuning fork and place on vertebral spinous process. 3. Assess for change in symptoms, reproduction of symptoms. 4. If positive, refer out for X-Ray.

Question 55

Thoracic outlet Tests

Answer 55

1. Roos test
2. Costoclavicular test
3. Hyperabduction test
4. Adson’s test
5. Supraclavicular pressure test

Question 56

Roos test

Answer 56

Purpose: To assess thoracic outlet integrity
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Ask patient to abduct shoulders to 90° with 90° elbow flexion. 3. Ask patient open and close hands (like sock puppets) for 3 minutes. 4. Assess change in symptoms. 5. (+) test = reproduction of pain, numbness, tingling, color change.

Question 57

Costoclavicular test

Answer 57

Purpose: To assess thoracic outlet (clavicle on 1st rib)
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Assess patient’s radial pulse. 3. Ask patient to sit up very straight (military posture). 4. Passively extend patient’s shoulder with scapular adduction for 30 seconds. 5. Assess strength of radial pulse. 6. (+) test = diminished pulse or reproduction of symptoms.

Question 58

Hyperabduction test

Answer 58

Purpose: To assess thoracic outlet (Pectoralis Minor tightness)
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Assess patient’s radial pulse. 3. Passively take patient into full abduction with over pressure for 30 seconds. 4. Assess strength of radial pulse. 5. (+) test = diminished pulse or reproduction of symptoms.

Question 59

. Adson’s test

Answer 59

Purpose: To assess thoracic outlet (Scalene hypertonicity)
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Assess patient’s radial pulse. 3. Passively extend patient’s shoulder with slight abduction 4. Ask patient to take a deep breath and hold it, then extend and rotate head toward test side, hold for up to 30 seconds. 5. Assess strength of radial pulse. 6. (+) test = diminished pulse or reproduction of symptoms.

Question 60

Supraclavicular pressure test

Answer 60

Purpose: To assess thoracic outlet (Scalene hypertonicity)
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Place fingers on upper trapezius and thumbs on lowest portion of anterior scalene muscle near first rib. 3. Squeeze fingers and thumb together for 30 seconds. 4. Assess change in symptoms. 5. (+) test = reproduction of symptoms.

Question 61

Extension/Rotation SNAG

Answer 61

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Therapist places palm on thoracic spine just below level of involvement, then glide up to take up skin slack. 3. Patient extends while therapist maintains glide. 4. Patient returns to neutral. 5. Glide is maintained until patient returns to neutral. 6. Release glide and repeat.

Question 62

Upper T/S reverse NAG

Answer 62

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Therapist uses thumb and index finger to make a wedge over involved segment (T1 or T2) spinous process. 3. Apply posterior to anterior pressure. 4. Wrap other arm around patient’s head and move patient’s head into retraction. 5. Release retraction and PA and repeat.

Question 63

Upper T/S SMWAM

Answer 63

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Assess shoulder flexion ROM. 3. Therapist places one thumb on lateral surface of T1 spinous process and other thumb on opposite lateral surface of T2 spinous process. 4. Apply a rotational glide in opposite directions to T1 and T2. 5. Ask patient to flex shoulder. 6. Assess change in symptoms and ROM

Question 64

Anterior glide rib

Answer 64

(isometric mobilization or MET—Pectoralis Major)
1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Ask patient to place ipsilateral arm on opposite shoulder. 3. Therapist applies horizontal abduction force to shoulder while patient resists. 4. While applying horizontal abduction, Therapist applies a posterior to anterior directed force to rib that is held posteriorly. 5. Reassess symptoms and rib position.

Question 65

Posterior glide rib

Answer 65

(isometric mobilization or MET—Serratus Anterior)
1. Patient is supine on plinth. Resting symptoms are assessed. 2. Ask patient to punch ipsilateral arm up towards ceiling. 3. Therapist applies posteriorly directed force through arm. 4. Therapist can add an anterior to posteriorly directed force to rib being mobilized.

Question 66

First rib inferior glide

Answer 66

1. Patient is seated on edge of plinth. Resting symptoms are assessed. 2. Therapist uses 2nd metacarpal head to apply an inferiorly directed force to 1st rib behind clavicle.