Cervical and Thoracic Ortho Tests Flashcards
What test is used to assess muscle strength?
Oxford scale 0-5
5/5 is normal
What muscles do you test for T12-L3?
Hip flexors
- Patient is seated with legs hanging off the table and feet off the floor.
- Tell patient to lift thigh off the table and resist motion that is being applied downward
What muscles do you test for L3?
Knee Extension
- Patient is seated with legs hanging off the table and feet off the floor.
- Brace patients femur and grab distal tibia then tell patient to extend their knee and resist the downward pressure on the distal tibia.
What muscles do you test for L4?
Anterior Tibialis
- Patient seated with legs hanging freely and feet off the ground positioned by me in dorsiflexion.
- Tell patient to resist force that is applied up and in
What muscles do you test for L5?
Extensor Hallicus Longus
- Patient seated with feet flat on the ground with big toe in extension.
- Tell patient to resist against downward pressure with big toe.
What muscles do you test for S1?
Fibularis Longus/Brevis
- Patient is seated with legs hanging off table with feet flat on the ground and you position their foot into flexion and eversion.
- Tell patient to resist against force in the direction of dorsiflexion and inversion
L4 sensory test goes from where to where?
Medial tibia to medial 1st toe
L5 sensory test goes from where to where?
Anterolateral tibia to dorsum of foot including toes 2 and 3
S1 sensory test goes from where to where?
Fibula to lateral 5th toe
What is the reflex scale?
Wexler Scale 0-4
2/4 is normal
Where do you tap the reflex hammer for C5/C6?
Biceps tendon
Where do you tap the reflex hammer for C6?
Two hammer rolls up from the thumb on the brachioradialis tendon
Where do you tap the reflex hammer for C7?
On the triceps tendon
Where do you tap the reflex hammer for L4?
Infrapatellar tendon
Where do you tap the reflex hammer for S1?
Achilles tendon
Cervical flexion with inclinometer
Patient seated
Inclinometer on top of head and T1
Subtract bottom number from the top number for flexion value
Cervical extension with inclinometer
Patient seated
Inclinometer placed on top of patients head and on the spine of the scapula
Subtract bottom number from the top number for extension value
Lateral flexion with inclinometer
Patient seated
Inclinometer on top of occiput and on T1
Subtract bottom from top for lateral flexion value
Cervical rotation with inclinometer
Patient lying down
Inclinometer on patient forehead and have them rotate to both sides for rotation value
What is the normal values for thoracic flexion?
20-45 degrees
What are the normal values for thoracic extension?
25-35 degrees
What are the normal values for thoracic lateral flexion?
20-40 degrees
What are the normal values for thoracic rotation?
35-50 degrees
Thoracic flexion with inclinometer
Patient standing
Inclinometer on T1 and L1 and flex forward
Subtract bottom from top for thoracic flexion value
Thoracic extension with inclinometer
Patient standing
Inclinometer is on T1 and L1 and extend backwards
Subtract bottom from top for extension values
Thoracic lateral flexion with inclinometer
Patient standing
Inclinometer on T1 and L1 then laterally flex to both sides
Subtract bottom from top number for lateral flexion value
Thoracic rotation with inclinometer
Patient in child pose position
On hand goes behind head or behind back then look/turn that direction as far as possible
Inclinometer on T1 and L1
subtract bottom from top for thoracic rotation value
Lumbar flexion with inclinometer
Patient standing
Inclinometer on L1 and S2 then flex forward and subtract the bottom from the top for flexion value
Lumbar extension with inclinometer
Patient standing
Inclinometer on L1 and off to the side of S2 then have patient extend backwards
Subtract bottom from top for extension value
Lumbar lateral flexion with inclinometer
Patient standing
Inclinometer at the level of L1 and S2 then have patient laterally flex to both sides
Subtract bottom from top to get lateral flexion values
Why is Active Supine Occipito-Atlantal Cervical Flexion used and what is its procedure?
Used when a cervical flexion restriction is identified and helps to differentiate between upper and lower cervical dysfunction
- I would passively rotate the patients head as far as patients comfort then instruct patient to bring their chin to chest
- 20 degrees of occipital flexion is considered normal
What are the interpretations of the active supine occipito-atlantal cervical flexion test?
-If the patient can successfully nod their head 20 degrees, the lower cervical spine is most likely responsible for the restriction
- If the patient cannot nod their head 20 degrees, the upper cervical spine is most likely responsible for the restriction
Why is Cervical flexion rotation test used and what is the procedure?
Used when a cervical restriction is identified and helps to differentiate between upper and lower cervical rotation dysfunction
- I would passively flex the C-spine maximally and support their head
-Tell patient to rotate their head to one side, Hopefully to 45 degrees
What are the interpretations of the Cervical flexion rotation test?
- Pain during the first 45 degrees is indicative of upper cervical involvement
- If the patient can successfully rotate their head 45 degrees, then the lower cervical spine is most likely responsible for the restriction
- If the patient cannot rotate their head 45 degrees, the upper cervical spine is most likely responsible for the restriction
What are the procedures of O’Donoghue Maneuver?
Active ROM
Passive ROM
Resisted ROM/Isometric contractions
What are the interpretations of O’Donoghue Maneuver?
- Pain during active or resisted ROM signifies muscle strain
- Pain during passive ROM signifies ligamentous sprain
What are the procedures of the Cervical/Axial Compression Test?
Patient seated, sitting straight and looking forward.
I apply a progressively downward compression on the head
What are the interpretations of Cervical/axial compression test?
- A positive test is radiating pain into the arms or local pain in spine
- Test is indicative of nerve root compression due to foraminal stenosis, osteophytes; a space occupying lesion, or facet encroachment.
What are the procedures of Jackson Cervical compression test?
Patient seated, sitting straight up
I ask them to rotate their head to the unaffected side
I apply an axial compression onto the head
What are the interpretations of Jackson Cervical Compression Test?
- A positive test is radiating pain into the arms
- Test indicates nerve root compression from foraminal stenosis, osteophytes, space-occupying lesion, herniated disc, and fracture.
What are the procedures of the Modified Spurlings test?
The patient is seated and instructed to extend their head.
I laterally flex them toward the unaffected side and apply an axial load
What are the interpretations of Modified Spurlings
- Patient notes any pain or parathesia and the distribution thereof.
- This maneuver closes the intervertebral foramina on the side of the lateral flexion and reproduces the patients pain of radiculopathy indicating nerve root compression
What are the procedures of the Maximum Cervical Compression Test?
Patient seated, and asked to extend, laterally flex, and rotate towards the side of testing
What are the interpretations of Maximum Cervical compression
-Pain on the concave side indicates nerve root compression or facet involvement
-Pain on the convex (stretched) side indicates muscular strain
What is the procedure for Upper Limb Tension Test
**Median Nerve Bias
Patient lying down
Depress patients shoulder and grab their digits and push them into extension then slowly extend the e arm
What are the interpretations of Upper Limb Tension Test
-Positive test is a reproduction of the patient’s symptoms, indicative of MEDIAN nerve entrapment
What are the procedures of the Cervical Distraction Test
Patient seated and examiner behind patient. Examiner grasps the base of the patients head and slowly lifts vertically
What are the interpretations of Cervical Distraction Test
- This pressure removes the weight of the patients head from the neck
- Generalized, INCREASED pain indicates muscle spasm or sprain/strain
- RELIEF of pain indicates intervertebral foramina encroachment of facet capsulitis
What is the procedure for Foraminal Compression Test
Patient seated,
Doctor laterally flexes their head to unaffected side.
Examiner slowly pushes down on the head
Interpretation of Foraminal Compression test
- The test is positive if pain radiates into the arm
- A positive test indicates nerve root compression
What is the procedure for Shoulder Abduction Relief test? (AKA Bakody’s sign)
In a seated position, the patient actively places the palm of the affected extremity on top of the head, raising the elbow to a height approx. level to the head
What are the interpretations of Shoulder Abduction Relief test (AKA Bakody’s Sign)
- By elevating the suprascapular nerve, traction of the upper trunk of the brachial plexus is relieved
- A cervical nerve root compression is suggested by a positive result. Overall this decreases stretch on compressed nerve root
- The sign is present when the radiating pain is lessened or completely gone
What is the procedure for Shoulder Depression Test?
Patient seated, examiner laterally flexes the C-Spine away from the affected shoulder and then depresses the affected shoulder
Interpretations of Shoulder Depression Test
- This sign is positive if radicular pain is produced or aggravated.
- A positive sign indicates adhesions of the dural sleeves, spinal nerve roots, or adjacent structures of the joint capsule of the shoulder.
What are the procedures of the Spinal Percussion test?
Patient seated with head slightly flexed.
Examiner percusses the spinous process and associated musculature of each of the cervical vertebra with a neurologic reflex hammer
Interpretations of Spinal Percussion test
- Evidence of localized pain indicates a possible fractured vertebra.
- Evidence of radicular pain indicates a possible disc lesion
- A ligamentous sprain will cause pain when the spinous processes are percussed
What is Rust sign?
If the patient spontaneously grasps the head with both hands when lying down or when arising from a recumbent position, this is a positive sign of instability because of a sprain, RA, fracture or severe cervical subluxation
What is the procedure for Valsalva Maneuver?
Patient seated, ask them to inhale deeply and hold their breath while bearing down abdominally
What are the interpretations of Valsalva Maneuver?
- A positive test indicated by increased pain cause by increased intrathecal pressure.
- Increased intrathecal pressure is usually caused by a space-occupying lesion (herniated disc, tumor, osteophytes)
What are the procedures for Dejerine Sign?
Ask the patient is they have any pain with coughing, sneezing or bowel movements.
What are the interpretations of Dejerine sign
- This aggravation results from the mechanical obstruction of spinal fluid flow
—-Herniated disc, spinal cord tumor or spinal compression fracture
What are the procedures for Lhermitte sign
Patient is seated and examiner passively flexes head forward
What are the interpretations of Lhermitte sign
- Electric shock sensation down the neck indicates multiple sclerosis
- Sharp pain radiating down the spine and into the upper or lower limbs is a positive for cord pathology
- Dural irritation, tumor, or dens fracture all possible implications.
What is the procedure of Brudzinski sign?
Patient is lying supine and the examiner passively flexes the patients head
What are the interpretations of Brudzinski sign?
- The sign is positive if flexion of both knees occurs
—–Present with meningitis
What is the procedure of Soto-Hall sign
The patient is lying supine
Examiner places knife-edge on the sternum and applies slight pressure and with other hand under the occiput examiner flexes patients head towards their chest
Interpretations of Soto-Hall sign
- Used when fracture of a vertebra is suspected
- When the SP of the injured vertebra is reached, the patient experiences a noticeable local pain
- Positive indicates subluxation, exostoses, disc lesion, sprain or strain, vertebral fracture or meningeal irritation
What is the procedure for the Deep Neck Flexor Endurance test?
Patient is lying supine with their chin maximally retracted.
The examiner instructs them to lift their head while maintaining that chin tuck for more than 40 seconds.
The examiner holds their hand under the patient’s head but does not help them keep a lift.
Interpretations of Deep Neck Flexor Endurance
- Establish a strength/ endurance baseline.
- Inability to maintain the position for at least 39 seconds for males, 29 for females indicates weak deep neck flexors
Deep neck flexor muscle test procedure
Patient lying supine with their shoulder at 90 degrees of abduction and external rotation. Elbows in 90 degree of flexion.
Patient is asked to lift their head with chin tucked.
Examiner adds A-P pressure to the patients forehead
SCM and scalene muscle test procedure
Patient lying supine
Shoulders in 90 degree abduction and external rotation. Elbows at 90 degrees of flexion
Patients head turned to opposite side of testing
Patient keeps head off table while keeping shoulders flat
Examiner adds A-P and L-M pressure to temporal region on patients head
Posterolateral Neck Extensors muscle test procedure
Patient lying prone
Shoulders in 90 degrees of abduction and external rotation. Elbows bent at 90 degrees flexion
Patient looking towards the side of testing.
Muscles tested: Ipsilateral splenius capitis & cervisis, Semispinalis capitis & cervicis, cervical spinal erectors. Contralateral upper trapezius.
Examiner adds L-M and P-A pressure to Posterolateral occiput
Upper trap muscle test procedure
Patient seated or prone
Head turned to side opposite of testing
Patient elevates same side shoulder approximating occiput and acromion process
Examiner adds P-A and L-M pressure to posterior occiput
AND
S-I pressure on acromion process
What is the procedure for Allen’s test
Patient seated with abducted shoulders and elbows flexed at 90 degrees while making and releasing 10 fists.
After 10, patient holds a fist and the examiner grabs both Radial and Ulnar arteries and brings the arm down.
Examiner tells the patient to release the fist and lets go of one pulse to see if color returns in 5 seconds or less.
Repeat for other pulse
What are the ortho tests for Thoracic Outlet?
Roos Test
Adsons Test
Wright’s test (Hyperabduction Test)
Costoclavicular Maneuver
sometimes hyperabduction maneuver
Scalenus Anticus/Adson’s Test procedure
Examiner locates the radial pulse of the involved extremity
Patients head is extended and rotated to the involved side
Examiner externally rotates and extends the patients shoulder then asked the patient to take a big breath in and hold it.
Interpretations of Scalenus Anticus/Adson’s Test
Loss of pulse/reproduction of symptoms is considered a positive test
A positive test is indicative of compression of the neurovascular bundle between the middle and anterior scalenes
What is the procedure of Hyperabduction Maneuver (Wright’s test)
Patient is seated, both arms by sides
Examiner palpates for radial pulse and passively abducted to 180 degrees
—-Examiner notes the angle of abduction at which the radial pulse diminishes or disappears on the affected side
Interpretations of Hyperabduction Maneuver/Wright’s test
A true positive is reproduction of symptoms
The test is significant of neurovascular compromise of the axillary artery and stretches the Pec Minor
This test has many false positives
What is the procedure of Costoclavicular Maneuver
Patient is seated and asked to flex their head forward
Examiner palpates for BOTH radial pulses and brings the arms into extension
Interpretations of costoclavicular maneuver
If the pulse is lost, the test is positive
A true positive is reproduction of the patient’s arm complaints
Compression between the 1st rib and the clavicle is suggested by a positive test
Procedure of Roos Test/Elevated Arm Stress Test
Both arms are abducted and elbows flexed to 90 degrees while slowly opening and slowing fists for 3 minutes
Interpretation of Roos Test/Elevated Arm Stress Test
If patient is unable to keep their arms in starting position, has pain, numbness or tingling before 3 minutes the test is considered a positive of TOS on effected side
Minor fatigue and distress are considered negative tests
What are the thoracic spine ortho tests
Spinal percussion test
Adam’s test
Forestier’s test
Procedure of spinal percussion test
Assessment of spinal osseous integrity
Patient seated/standing with their thoracic spine slightly flexed
Examiner percusses the spinous processes
Interpretation of spinal percussion test
Evidence of localized pain indicates a possible fractured vertebra
Evidence of radicular pain indicates a possible disc lesion
Other conditions can elicit a positive pain response
Procedure of Adam’s Test
Assessment for pathologic or structural scoliosis
Patient has shoes off and feet together
Examiner asked patient to flex forward and look for rib humps
Interpretations of Adams Test
A functional scoliosis will resolve upon forward flexion
A structural scoliosis will remain present
A trunk angle greater than 7 degrees is an indication of a structural curve of at least 20 degrees
Procedure of Forrestier’s test
Patients shoes off, feet together, arms down by their sides or hands on hips
Ask patient to laterally flex to both sides
Interpretation of Forrestier’s test
As patient laterally flexes the spine should curve sideways in a smooth even sequential manner
The examiner should look for any tightness of abnormal angulation which could indicate hypomobility or hypermobility at a specific segment
If the ipsilateral paraspinal muscles tighten or their contracture is evident, ankylosing spondylitis or pathology causing muscles spasm should be considered
What are the 6 rib ortho tests?
Schepelmann Sign
Costovertebral stress
Chest expansion test
Rib motion test
Sternal compression test
Lateral chest (rib) compression
Procedure for Schepelmann sign
The patient raises their arms while standing
Examiner asks them to laterally flex to both sides
Interpretations of Schepelmann sign
Pain created in the concave side is indicative by intercostal neuritis
Pain created on the convex side is indicative of intercostal myofascitis
——Intercostal myofascitis must be differentiated from the fibrous inflammation of pleurisy
Procedure of Costovertebral stress test
Patient is seated, arms crossed in front of them
Examiner asks them to rotate their torso then examiner applies stress at the angle of the ribs
Interpretation of Costovertebral stress test
Pain may be induced on the same side of a costovertebral or costosternal irritation
Loss of movement indicates fixation of the cosotransverse and or costovertebral articulation in posterior and anterior translation (Caliper movement)
Procedure for chest expansion test
Chest diameter is measure at the 4th intercostal space/xyphoid process
The first measurement is taken as the patient exhales maximally
A second measurement is taken as the patient inhales deeply
Interpretation of chest expansion test
The normal difference between inspiration and expiration is 1.5 inches for females and 3 inches for males
Decreases, in the absence of trauma, suggest ankylosing spondylitis
Procedure for Posterior Respiratory Excursion
Patient seated
Chest expansion symmetry can be evaluated by placing the thumbs and index fingers around the posterior thorax surface
Thumbs should start touching over the midline while the patient exhales
The thumbs should then separate equally on full inspiration
Interpretation of Posterior Respiratory Excursion
Asymmetry may be seen in painful rib problems, collapsed lung (atelectasis) or pneumonia
Procedure for Anterior Rib Motion Test
Assessment for Hypomobile Costal Structures
Patient lying supine
Examiner asks them to inhale, then exhale. A-P movement of the ribs is palpated
Interpretation of Anterior Rib Motion Test
Restriction in motion is noted
Rib failing to move inferior during exhalation suggest a fixed elevated rib
Rib failing to move superior during inhalation suggest a fixed depressed rib
Procedure for Sternal Compression Test
Patient is lying supine
Examiner uses a knife edge contact on patients sternum and applies a downward pressure
Interpretation of Sternal Compression Test
Localized pain at the lateral border of the ribs indicates a rib fracture
Pain reproduced along any part of the rib is indicative of rib fracture
Procedure of Lateral Chest (Rib) Compression
Patient seated
Examiner contacts both lateral aspects of the rib cage and applies bilateral, lateral to medial compression
Interpretation of Lateral Chest (Rib) Compression Test
Pain at the costosternal junction = local inflammation
Pain in the back = Costotransverse or costovertebral lasions
Localized pain at the lateral rib angle = fracture
Functional test procedure for Prone (Thoracic) Extension
Assessment for structural hyperkyphosis
Patient lying prone with hands on their low back
Examiner asks them to lift their chest off the table
Functional test interpretations of Prone (thoracic) Extension
If kyphosis persists it is a “structural” kyphosis
Functional test procedure for Seated Spinal Rotation
Determine if the patient has good spinal rotation bilaterally
Patient seated at the corner of the table
Patient crosses the leg of testing side over top of the other to limit pelvic movement
Patient puts hands on hip and rotates as far as possible to the side of top leg
What is the motor and sensory of C5?
Motor = Deltoid
Sensory = Lateral upper arm to elbow
What is the motor and sensory of C6?
Motor = Biceps and wrist extensors
Sensory = Lateral lower arm to thumb and web
What is the motor and sensory of C7?
Motor = triceps and wrist flexors
Sensory = Middle lower arm from elbow to 5th digit
What is the motor and sensory for C8?
Motor = finger flexors
Sensory = Medial lower arm from elbow to 5th digit
What is the motor and sensory of T1?
Motor = Interossei
Sensory = Medial upper arm from elbow to axilla
