Cervical Functional/Special Tests Flashcards
Scanning Cervical Exam Requirement
-VBI
-Alar Ligament
-Transverse Ligament
5 Ds
-Dizziness
-Dysarthria
-Dysphagia
-Diplopia
-Drop Attacks
3 Ns
-Numbness/tingling
-Nystagmus
-Nausea
Physical Examination Components
- Pt Hx
- Systems Review
- Observation (body, face and eyes)
- Screening (VBI/TL/AL)
- Scanning Exam (if needed)
- Upper and lower c-spine/UE/Thoracic AROM>PROM>RROM
- Flexibility
- Muscle
- Joint Play
- Palpation
- Special Tests
3 Mandatory Qs for Neck Pain
- Dizziness, blackouts or drop attacks?
-Ds and Ns
-VBI - Hx of RA/arthritis or steroids?
- Any neuro in legs?
Optional: Down Syndrome
-ligamentous laxity
Canadian Cervical Spine Rule
-guidlines for immobilization and/or imaging after trauma to neck
-positive= refer
- High risk factor for immobilization (any of these)
->65
- dangerous MOI
-Numbness and tingling in extremities - Low risk factor for assessment of ROM
-Complex rearending
-cannot sit up in ED
-cannot ambulate
-immediate neck pain
-pain at midline of c-spine - Can Pt voluntarily actively rotate 45deg
-yes: treat
-no: immobilize and image
Modified Sharp Purser Test
-1st test done for Transverse lig and AA stability
-relocation test
- Pt in sitting
- Chin tuck to move C1 on C2 for 5s
- Ask about Ds and Ns and “clunk”
- Pt Pincer’s C2 SP and post/sup pressure on forehead
(+): S/s are reduced
Supine Lift-Off Test
-secondary test for Transverse lig and AA stability
- Pt supine
- PT finger in squish of C1 and push anteriorly
(+): Pt has excessive upper cervical mobility of C1 w/o movement of C2 and below
Alar Ligament Test
-assess alar ligs and OA stability
- Pt in supine
- PT pincer on C2 SP
- PT passively SB or Rot
(+): immediate CONTRA movement of C2 not felt
Vertebral Basilar Screen
-assess VBA
- Pt supine
- PT passively Extends head
- Rotate L
- Rotate R
- Ext w/ Rotation R
- Ext w/ Rotation L
ask about Ds and Ns for Each
If (+) w/ extension, test ROT to determine side
(+): Presence of Ds and Ns in any position
Cervical Spine Exam
AROM>(measure)>PROM
-seated
Upper Cervical 1st (5-10dg flx and 45 rotation):
-Flexion (chin tucks)/Extension
-Pt uses 2 hands to stabilize w/ overpressure
Lower Cervical 2nd (35-70 flx and 30-40 rot and 15-40 SB:
-Flx/Ext/LSB/Rotation
-Quadrant testing
Cervical MMT
-test in neutral
Flexion:
-C1-C2 and CN 11
Extension
Side Bending:
-C3 and CN 11
Rotation:
-C2
Facet Joint Dysfunction Thoracic HVLAT CPR
CPG:
1. S/s <30 days
2. No s/s distal to shoulder
3. Looking up doesn’t agg s/s
4. FABQ physical activity <12
5. Diminished upper t-spine kyphosis
6. Cervical ext ROM <30deg
(+) > or = 3, successful outcome w/t-spine HVLAP in 86% of Pts
ICF Model: Neck Pain w/ Mobility Deficits
-hypomobility
S/s:
-Pain in central (older stenosis) or Unilateral (younger foramena)
-limited ROM that constantly reproduces s/s
-possible referred pain
Exam:
-Dec ROM
-Neck pain at end ranges
-Restricted mobility in c and t-spine
-referred pain reproduced w/ provocation
-deficits in cervico-scapulo-thoracic strength
Treatment:
-T-spine manips
-C-spine manual
-Cervical ROM
-Strengthening
ICF Model: Neck Pain w/ Movement Coordination Impairments
-Instability
S/s:
-MOI linked to trauma/whiplash or hypermobility
-referred shoulder pain
-HA, concussion, confusion, hypersensitivity
Exam:
-(+): cranial cervical flexion test
-(+): Neck flexor muscle endurance test
-(+): Pressure algometry
-Neck pain at midposition to end
-Dec strength
-Point tenderness
Treatment:
-Pt education and prognosis
-Increase ROM
-Manual or exercise
-Pain science
ICF Model: Neck Pain w/ Headaches
S/s:
-non-continuous, unilateral neck pain (facet joint) and referred HA
-HA precipitated or aggravated by neck movements or positions
Exam:
-(+): Cervical flexion rotation test
-HA reproduced w/ provocation
-Limited ROM
-Strength and endurance deficits
Treatment:
-Mobility
-Self SNAGs to AA joint
-Manual therapy c and t-spine
ICF Model: Neck Pain w/ Radiating Pain
-Radiculopathy
S/s:
-neck pain w/ UE radiating pain
-UE neruological signs
Exam:
-(+): Cervical radiculopathy CPR
-UE sensory, strength deficits
Treatment:
-Exercise and MT
-Cervical collar for short term
-Intermittent traction
-Pt education
UE ROM
-Cervical
-Shoulder, elbow, wrist, and fingers
-Thoracic
Flx/ext/abd/IR/ER
- AROM –> reproduction of local s/s
- AROM –> reproduction of remote s/s
- AROM –> no impact on s/s
Trapezius Muscle Length
-only check if motion IS limited
must check length if you prescribe stretch later
- Pt supine
- Flex head > contra SB > ipsi rotation
- PT depresses ipsi shoulder
Normal: 45deg of rot w/ soft end range
Decreased:<45 or hard end range
Levator Muscle Length
-only check if motion IS limited
must check length if you prescribe stretch later
- Pt supine
- Flex head > contra SB and ipsi rotation
- PT depresses ipsi shoulder
Normal: 45deg of rot w/ soft end range
Decreased:<45 or hard end range or TTP
Scalenes Muscle Length
-only check if motion ISN’T limited
must check length if you prescribe stretch later
- Pt supine w/ head off plinth
- Extend and contra SB while stabilizing ipsi
- PT stabilizes ipsi shoulder
Normal: 45deg of SB
Decreased:<45 of SB
SCM Muscle Length
-only check if motion ISN’T limited
must check length if you prescribe stretch later
- Pt supine w/ head off plinth
- Contra SB and extension
- PT stabilizes ipsi shoulder > rotates ipsi
Normal: Equal range Bilat
Decreased: Unequal range bilat
OA Joint Mobilization Opening/Closing
-Normal, Hypo, Hyper
-Push C1 TP
Opening R:
-CV flexion w/ L Sideglide
Opening L:
-CV Flexion w/ R sideglide
Closing on R:
-CV ext w/ R sideglide
Closing on L:
-CV ext w/ L sideglide
AA Joint Mobilization
-rotation only
-Normal, hypo, hyper
- Pt flexes mid-cervical to lock out upper
- Pt rotates neck to each side
PA Springing Joint Mobility
-assess C2-T1
-Can be SP (central) or facet joint (unilateral)
-Pt in prone
-Down and medial force
C7 will disappear w/ ext
Sideglides Joint Mobility
-C2-T1
-Sideglides on facet joints
-Normal, hypo, hyper
Flexion (Opening Restriction):
1. PT Flex neck at segment assessed
2. Sideglides to L to open R
3. Sideglides to R to open L
Extension (Closing Restriction):
1. PT extends neck at segment assessed
2. Sideglides to L to close L
3. Sideglides to R to close R
Palpation
-Reproduction of s/s
-hypertonicity
-Atrophy
-Subocc
-Traps
-Levator
-SCM
-Scalenes
Closing Restriction
Issues with:
-extension, SB, Rotation
-IPSI side of pain
Opening Restriction
Issues with:
-flexion, SB, rotation
-CONTRA side of pain
Cervical Compression and Distraction
Normal: flx/ext, LSB, rot
Provocation: compression and distraction, 5-8s
Pain Reproduced w/ Compression:
-herniation
-end plate/fx
-arthritis
-nerve root
Pain Reproduced w/ Distraction
-spinal lig tear
-tear of annulus fibrosis
-spasm
-dural irritability
-cervical instability
Quadrant Testing
-spine pathology
-Flx and RSB: disc on left or LOR
-Flx and LSB: disc on right or ROR
-Ext and RSB: foramen on right or RCL
-Ext and LSB: foramen on left or LCL
Spurling Test
-test for cervical radiculopathy
-Compresses foramina
- Pt seated
- PT asked Pt to SB > applies overpressure for 5-8s
- Repeat on opp
(+): reproduction of s/s into Ipsi shoulder
Cervical Radiculopathy CPR
- C-spine rot to painful side <60deg
- (+) Spurling test
- (+) ULLT#1
- (+) Cervical Distraction (relieves)
4/5: 90%
3/5: 65%
Cranio-Cervical Flexion Test
-assesses neck endurance of deep flexors
-for movement coordination deficis
- Pt in supine hooklying w/ biofeedback cuff behind head
- Cuff inflated to 20 mmHg
- Pt nods for 10s at 22mmHg
- Rest for 10s and start again adding 2 mmHg
- Test ends when Pt can no longer hold
Activation Score: max pressure held for 10s
Performance Index: max pressure held for 10s x reps
Neck Flexor Endurance Test
-assesses neck flexor endurance and motor control
- Pt in supine in hookyling
- Pt tucks chin and lifts head 1 inch off the table
- Test ends when you can no longer hold up head
(+) for women: <38.9s
(+) for men: <29.4
Cervical Flexion-Rotation Test
-assesses for presence of cervicogenic HA
-provocation test
- Pt in supine w/ maximal neck flx and hold
- Apply pressure through rotation to both sides and note any change in s/s
(+): Rotation ROM loss to 1 side >10deg compaired to opp OR reproduction of s/s
Shoulder Abduction Test
-assess for presenve of radicular s/s
-usually rules out shoulder
- Pt seated w/ hand on top of head
(+): s/s arre reduced or relieved
not a good screening test
Canadian C-Spine Rule Not Applicable
-non trauma
-<15 GCS
-unstable vitals
-<16 years
-Acute paralysis
-known vertabral disease
-previous c-spine surgery
-pregnant
Median Nerve ULTT 1
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
C5-T1
Contraindications for Neurodynamic Mobilizations
-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders
Neurodynamic Mobilization Techniques: Tension
-load opposite ends of nerve
-both “on” or “off”
-when glides no longer help
ex: head flx and ankle DF, the head ext and ankle PF
Neurodynamic Mobilization Techniques: Gliding
-load one end of nerve while relieving stress on opposite end
- 1 “on” and 1 “off” then switch
ex: head flx and ankle PF, the head ext and ankle DF
Neurodynamic Mobilization Techniques: Stretching
-load opposite ends of nerve and hold
-7-30s
-both “on” or “off”
-most aggressive
ex: head flx and ankle DF (hold), the head ext and ankle PF (hold)
Radial Nerve ULTT 2
- Use hand to depress scap
- GH IR
- Flexion wrist and fingers
- Forearm pronation
- Elbow extension
- GH ABD
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
C5-T1
Ulnar Nerve ULTT 3
- Use hand to depress scap
- Abduct
- GH ER
- Forearm pronation
- Extend wrist and fingers
- Elbow flexion
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/
C8-T1
OA Joint Mobilization
-Flexion 5-10deg supine
- Pt in supine
- PT fingers in occiput and shoulder on forehead with downward force
- PT flx OA and oscilate or sustain
OA Joint Traction
- Pt in supine
- PT fingers in occiput and shoulder on forehead for sttability
- PT distracts OA for 5-10s
AA Joint SNAG
-rotation self mobilization
- Pt in sitting
- Towel around upper neck
- Grab across w/ contra towel and pull towars shoulder and up
- Other hand pulling towel
AA Joint MET
- Pt in supine
- PT move head into contra (restricted side) SB and ipsi rotation
- Tell Pt to look to SB side (contra)
- Hold for 6 seconds
- Rotate more
Cervicogenic HA OA>AA>C2-C3
- Pt head in neutral; PA mobilization to C1 Lamina on affected side until point of pain
- Oscilate for 10s until s/s reduce
- Pt in ~30 ipsi rot (to pain); PA mobilization to C2 Lamina on affected side until point of pain
- Oscilate for 10s until s/s reduce
- Pt head in neutral; PA mobilization to C2 and C3 Lamina on affected side until point of pain
Seated Cervico-Thoracic Juntion Manipulation
- Pt in sitting at edge of mat toward PT
- PT behind Pt w/ arms around PT w/ hands on forearm
- Pt relaxes
- PT leans back to take up slack and HVLAT
Prone Cervico-Thoracic Juntion Manipulation
-gapping of C7-T1
- Pt in in prone w/ chin resting on table
- PT in on contra side of treatment
- PT has pisiform on TP of C7/T1
- Pt head SB to contra, rotated to ipsi
Containdications for Traction
-impaired cognitive function
-RA
-Osteoporosis
-Instability
-clautrophobia
-spinal tumors
-infection
-vascular compromise
-spondylolithesis
-very young or very old
Indications for Cervical Tractions
-neck pain w/ radiating or referred pain
-neck pain into upper arm
-spinal stenosis
-significant muscle spasms
Contraindications for Manual Therapy
-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated
Precautions for Manual Therapy
-Joint effusion or inflammation
-RA (non-exacerbation)
-Osteoporosis
-Pregnancy (over spine)
-Dizziness
-Steroid or anti-coagulant
Contraindications for Muscle Performance Training
-unstable angina
-uncotrolled HTN
-Hypertropic cadiomyopathy
-retinopathy
-pain
-inflammation
Cervical Traction Procedures
-10-40lbs or 7% of body weight
-20-30lbs needed for vertebral separation
Treatment:
-Static: 5-10mins
-Intermittent: 15 mins 50:10 off
avoid rebound effect
