Cervical Orthopedics

Question 1

Rusts Sign

Answer 1

patient grasps head with both arms

indicates severe upper cervical instability (fracture or sprain)

Question 2

Cervical ROM
Flexion
Extension
Lateral Flexion
Rotation

Answer 2

Flexion 60
Extension 75
Lateral Flexion 45
Rotation 80

Question 3

Libmans Sign

Answer 3

Press on mastoid until uncomfortable

demonstrates pain tolerance

Question 4

Bakody’s Sign

Answer 4

Patient places hand on top of head to relieve radicular pain symptoms
- decreases pressure on Brachial Plexus and Nerve Roots

Question 5

Reverse Bakody Sign

Answer 5

When patient places hand on top of head the symptoms are exacerbated
Indicated Thoracic outlet syndrome from interscalene compression

Question 6

Negative Bakody Sign

Answer 6

No change in pain or complaint

Question 7

Bikeles

Answer 7

Patient ABducts shoulder to 90 degrees (behind back) and then extends elbow fully
- stresses the brachial plexus, may cause radicular pain into arm

Question 8

Brachial Plexus Tension Test

Answer 8

ABduct shoulders to 90 degrees (to the side) and place hands behind head- Dr. pulls elbows back
- Stresses Brachial Plexus - may cause radicular pain

Question 9

Dejerines Sign/Triad

Answer 9

Patient will have radicular symptoms when coughing, sneezing or straining during defecation
- radicular pain caused by a SOL (herniated/protruding disc, compression fracture, tumor )

Question 10

Valsalva’s Maneuver

Answer 10

Patient Takes a breath and bears down
Testing for presence of SOL (patient may become dizzy due to lack of cerebral blood supply)
- increases intra-thecal pressure within spinal cord

Question 11

Swallowing Test

Answer 11

Presence of pain when patient is instructed to swallow

- indicates, space occupying lesion, ligament sprain, muscle sprain, fracture, osteophyte, tumor or disc protrusion

Question 12

Naffziger’s Test

Answer 12

Doctor stands behind a seated patient and occludes the external jugular vein at level of clavicles for 10-15 sec and then asks patient to cough

• Increases CSF pressure by pooling venous sinuses
• sharp pain at level of lesion is SOL is present

Question 13

Barre Lie’ou

Answer 13

doctor asks patient to rotate head back and forth as fast as they can

• rule out vascular insufficiency, cervicogenic vertigo and possible vestibular abnormalities
• pos = vertigo, dizziness, visual disturbances, nystagmus

Question 14

Vertebrobasilar Artery Maneuver

Answer 14

Auscultate the Carotid and Subclavian arteries
ask patient to rotate and hyperextend head to one side and count backwards from 20.
- this compresses vertebral arteries and is done to rule out vascular insufficiency
- pos = bruits, vertigo, dizziness, nausea, nystagmus,

Question 15

Dekleyn’s

Answer 15

Patient is Supine (head off table) and asked to rotate and hyperextend head to one side and count backwards from 20
- done to rule out vascular insufficiency
pos = bruits, vertigo, dizziness, nausea, nystagmus,

Question 16

Distraction Test

Answer 16

doctor puts upward pressure on patients head which removes weight of head
- Increased pain = muscle spasm
- Decreased pain = facet capsulitis/IVF encroachment
Purpose of this test is to confirm IVF encroachment

Question 17

Foraminal Compression test

Answer 17

Have patient actively rotate head from side to side - if no pain - doctor exerts strong downward pressure with head in neutral and then with their head rotated to one side or the other

• Done to confirm IVF encroachment and Nerve root Irritation
• localized pain = foraminal encroachment
• radicular pain = nerve root pressure

Question 18

Jackson Compression Test

Answer 18

first have patient actively rotate and laterall bend head - if no pain then continue
apply strong downward pressure with their head in the neutral position and then apply strong downward pressure with their head laterally flexed to either side
- positive sign indicates IVF encroachment
- Pain Ipsilateral = Facet/Nerve Root Involvement
- Pain Contralateral = Muscular Strain

Question 19

Maximum Cervical Compression Test

Answer 19

Patient is instructed to rotate, laterally flex and extend the neck
pain on concave side = nerve root involvement
pain on convex side - muscular strain
radiating pain - IVF encroachment
Local Pain - facet Capsulitis

Question 20

Spurlings

Answer 20

have patient actively rotate head from side to side - then lateral flex side to side - if no pain exert downward pressure in neutral, then exert downward pressure with head laterally flexed and extended. then with patient seated with head inneutral position doc delivers vertical blow to top of head.
- confirming IVF encroachment

Question 21

Lhermitte’s

Answer 21

patient seated - doctor instructs to drop chin to chest, then doctor adds passive flexion

• tractioning the posterior column of spinal cord
• shock like sensation down neck spine = posterior column disease
• sign of MS

Question 22

O’Donahue

Answer 22

Patient moves cervical spine through active range of motion, then through passive range of motion and then through resisted range of motion
- stresses musculature
- positives = strain or sprain 
Pain on Resisted ROM = Muscle Strain
Pain on Passive ROM = Ligament Sprain

Question 23

Kernigs Sign

Answer 23

Patient is Supine and doctor flexes hip and bends knee to 90 degrees then tries to extend the leg
- pain in head or spine or involuntary flexion of opposite knee or hip is indicative of Meningitis

Question 24

Brudzinski’s Sign

Answer 24

Patient Supine - doctor flexes head toward Xiphoid Process

-Pain or involuntary hip/knee flexion is indicative of meningitis

Question 25

Shoulder Depressor Test

Answer 25

doctor laterally flexes head away from side being tested and applies inferior pressure to ipsilateral shoulder

• tractions brachial plexus and nerve roots
• radicular symptoms may be caused by fibrosis, adhesions, osteophytes, cervical rib, edema or compression

Question 26

Soto Hall

Answer 26

Patient is Supine, doctor places one hand on sternum to hinder flexion in thoracics and then passively moves patients head into flexion

• done when compression fracture is suspected
• pulls posterior spinal ligaments
• pain can be caused by sprain/straing, avulstion fracture, facet involvement, SOL