Cervical and Thoracic Spine Tests Flashcards
Cervical Spinous Percussion
Positioning: pt seated, stand behind
Instruction: have pt bring chin to chest
Technique: hit each SP w/reflex hammer. strike firm enough that repeats aren’t necessary
Interpretation: +sharp pain - fracture
+dull pain - mets
+radiating pain - cervical lesion
Valsalva maneuver
Positioning: pt seated, stand to side
Instruction: take a big breath in and hold it, then bear down ilke struggling to move your bowels
Technique: observe pt
Interpretation: pos - radicular sxs down the arm (pain/numbness in dermatomal pattern; muscles weakness)
Cervical Compression Test
Positioning: pt seated, stand behind
Instruction: sit up tall, keep neck relaxed
Technique: interlace fingers and place hands on top of pt head - elbows resting on shoulders. take 5 seconds to apply increasing pressure straight down and then slowly release.
Interpretation: pos test is replication of radiculopathy
Spurling’s Test
Positioning: pt seated neutral, stand behind
Instruction: flex head (ear toward shoulder) to the side that has pain
Technique: interwoven fingers, elbows dropped; apply increasing pressure in combination compresion and side flexion (force is straight down).
Interpretation: pos test is replication of radicular pain
Maximal Foraminal Compression
Positioning: pt seated, stand behind
Instruction: look up over your shoulder on the painful side (creating rotation, extension, and lateral flexion)
Technique: apply compression if no pain (force is straight down)
Interpretation: part 3 of triad with cervical compression and spurling’s to recreate radiculopathy
Cervical Distraction Test
Positioning: pt seated, stand behind
Instruction: relax and don’t help
Technique: thenar eminence to mastoid, cup around the ears; lift with the legs
Interpretation: pos test is relief from sxs
Shoulder Depression Test
Positioning: pt seated, stand behind
Instruction: bring your ear toward your shoulder on the good side
Technique: pt head flexed laterally away, fingers to temple and thumb behind ear to stabilize the head; press straight down on the shoulder (stretching brachial plexus)
Interpretation: + dermatomal pain - radiculopathy
+non-dermatomal pain - plexus issue
Soto Hall/ Brudzinski Test
Positioning: patient supine
Instruction: bring one hand to your chest
Technique: bring one hand to patient’s and apply chest compression, then place other hand under occiput and maximally flex the neck
Interpretation: +local pain - joint/ligament injury, fracture
+radicular pain - disc lesion
+brudzinski’s sign (knees flex) - meningitis
Thoracic Spinous Percussion
Positioning: pt seated, stand behind
Instruction: have pt bring chin to chest and lean forward slightly
Technique: free hand to the back of patient’s neck for support; hit each SP w/reflex hammer. strike firm enough that repeats aren’t necessary
Interpretation: +sharp pain - fracture
+dull pain - mets
+radiating pain - cervical lesion
Forward Bending Test (Adam’s)
Positioning: pt standing; stand behind atient
Instruction: feet shoulder-width apart, slowly bend forward
Technique: observe the spine
Interpretation: trunk asymmetry (hump) indicates scoliosis that is structural. if hump disappears, it is functional scoliosis.
Adson’s Test
Positioning: patient seated, stand behind and find radial pulse by reaching around uderneath.
Instruction: turn your head to look over this shoulder. then take a deep breath and hold it.
Technique: feel if radial pulse diminishes. free hand on shoulder.
Interpretation: +lost pulse - vasculogenic TOS; scalene, cervical rib.
-same pulse - perform reverse adson’s
Reverse Adson’s Test
Positioning: patient seated, stand behind and find radial pulse by reaching around uderneath.
Instruction: turn your head to look over the opposite shoulder. then take a deep breath and hold it.
Technique: feel if radial pulse diminishes. free hand on shoulder.
Interpretation: +lost pulse - vasculogenic TOS; scalene, cervical rib.
Eden’s Test
Positioning: pt seated, stand behind; find radial pulse bilaterally with over the wrist grip
Instruction 1: sit up tall and straight, puff your chest
Technique: pull the arms back behind pt and continue feeling pulse
Instruction 2: take a big breath in, hold it and drop chin to chest
Interpretation: +loss of pulse. vasculogenic TOS. costoclavicular.
Roo’s Test
Positioning: pt seated, stand facing
Instruction: lift arms to shoulder height and externally rotate so hands point out to either side, and palms face forward; flex elbows 90 degs, rapidly open and close hands.
Technique: observe for 1 minute
Interpretation: +can’t keep it up. vasculogenic TOS. costoclavicular.
Wright’s Test
Positioning: pt seated; stand behind; find radial pulse bilaterally with over the wrist grip
Instruction: stay passive
Technique: abduct patient’s arms over shoulder height; continue feeling radial pulse in this position 1-2 minutes
Interpretation: +decreased pulse and/or parasthesia. hypertonic pectoralis minor or enlarged coracoid process
Allen Test
Positioning: patient seated, stand next to patient; one thumb to each of radial and ulnar arteries.
Instruction: raise your arm over head and bend your elbow; keep squeezing and releasing your fingers until i bring your arm down.
Technique: keep arteries pinched until hand blanches. bring arm down and release one artery, observe if color returns within five seconds. repeat with other artery.
Interpretation: general vascular check; + is some occlusion
Upper Limb Tension Test
Positioning: pt supine, arm will extend off table at mid-humerus; stand to injured side facing pt’s head.
Instruction: let me know when there’s pain
Technique:
- block shoulder girdle/stabilize scapula by placing inside hand at top of the soulder
- abduct the shoulder to 110 deg w/ slight coronal extension
- supinate forearm
- extend wrist and fingers
- ulnar deviation
- extend elbow
- have pt laterally flex head (to the opposite side)
Interpretation: +any reproduction of sxs at any stage. medial nerve tension or impingement (neurogenic TOS).
Breathing Pattern Test
Positioning: patient supine, stand to observe
Instruction: bring one hand to your upper chest, one hand just above your navel
Technique: watch patient breathe and see which hand rises first on inhale
Interpretation: diaphragmatic breathing good, thoracic breathing puts stress on scalenes and can irritate brachial plexus
Know the Canadian C-spine rules for X-rays
radiograp req’d if:
- neurological sxs present
- pt >65yo
- pt fearful of moving head on command
- pt involved in distraction-based injury
- pt demonstrates midline pain
Know the 4 tests used for Cluster Diagnosis for Cervical Radiculopathy
- cervical rotation less than 60 degs
- +ULTT
- +spurling’s
- +distraction
