Cervical Orthopedics Flashcards
Rusts Sign
patient grasps head with both arms
indicates severe upper cervical instability (fracture or sprain)
Cervical ROM Flexion Extension Lateral Flexion Rotation
Flexion 60
Extension 75
Lateral Flexion 45
Rotation 80
Libmans Sign
Press on mastoid until uncomfortable
demonstrates pain tolerance
Bakody’s Sign
Patient places hand on top of head to relieve radicular pain symptoms
- decreases pressure on Brachial Plexus and Nerve Roots
Reverse Bakody Sign
When patient places hand on top of head the symptoms are exacerbated
Indicated Thoracic outlet syndrome from interscalene compression
Negative Bakody Sign
No change in pain or complaint
Bikeles
Patient ABducts shoulder to 90 degrees (behind back) and then extends elbow fully
- stresses the brachial plexus, may cause radicular pain into arm
Brachial Plexus Tension Test
ABduct shoulders to 90 degrees (to the side) and place hands behind head- Dr. pulls elbows back
- Stresses Brachial Plexus - may cause radicular pain
Dejerines Sign/Triad
Patient will have radicular symptoms when coughing, sneezing or straining during defecation
- radicular pain caused by a SOL (herniated/protruding disc, compression fracture, tumor )
Valsalva’s Maneuver
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
Swallowing Test
Presence of pain when patient is instructed to swallow
- indicates, space occupying lesion, ligament sprain, muscle sprain, fracture, osteophyte, tumor or disc protrusion
Naffziger’s Test
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
Barre Lie’ou
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
Vertebrobasilar Artery Maneuver
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,
Dekleyn’s
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,
Distraction Test
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
Foraminal Compression test
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
Jackson Compression Test
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
Maximum Cervical Compression Test
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
Spurlings
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
Lhermitte’s
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
O’Donahue
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
Kernigs Sign
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
Brudzinski’s Sign
Patient Supine - doctor flexes head toward Xiphoid Process
-Pain or involuntary hip/knee flexion is indicative of meningitis
Shoulder Depressor Test
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
Soto Hall
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
