Cervical ROM and Orthopedic Tests Flashcards
cervical flexion ROM
50
shoulder Flexion ROM
180
elbow flexion ROM
140
when patient spontaneously grasps the head with both hands when lying down or when rising from a recumbent position
rust sign
rust sign indicates
- severe sprain
- rheumatoid arthritis
- fracture
- severe cervical subluxation
reporting statement for rust sign
severe upper cervical (atlanto-axial) instability
examiner applies thumb pressure to mastoid process and gradually increases pressure until it becomes noticeably uncomfortable
libman’s sign
patient in a seated position and will place palm of the affected extremity on top of their head, raising the elbow to the level of the ear
- bakody sign
- positive reverse bakody sign
- negative bakody sign
this test decreases traction of the lower part of the brachial plexus
- bakody sign
- positive reverse bakody sign
- negative bakody sign
when the decrease in traction of the lower part of the brachial plexus relieves pain
bakody sign
when the decrease in traction of the lower part of the brachial plexus is exacerbated
positive reverse bakody sign
when the decrease in traction of the lower part of the brachial plexus yields no change in the patients symptoms
negative bakody sign
purpose of bakody sign
it is a position that the patient will assume if they are having severe radicular symptoms, indicates nerve root irritation
positive reverse bakody sign indication
TOS from interscalene compression
negative bakody sign indication
rules out a nerve root (IVF) encroachment and thoracic outlet syndrome
patient is asked to abduct the shoulder 90 degrees and then the elbow is put into full extension
bikele’s sign
purpose of bikele’s sign
to traction the brachial plexus
what does bikele’s sign indicate
that the arm pain in question is radicular in nature and goes into the arm
patient is asked to abduct both shoulders to 90 degrees and place the hands behind the head. the doctor then pulls the elbows back
brachial plexus tension test
doctor stands in front of the seated patient and patient is asked to take in a breath and bear down as if they were laboring during a strenuous defecation
valsalva’s maneuver
purpose of valsalva’s maneuver
test for SOL w/in spinal column
coughing, sneezing and straining during defecation may cause aggravation of radiculitis symptoms. this aggravation is due to the mechanical obstruction (SOL) such as a herniated or protruding IVD, spinal cord tumor, or spinal compression fracture
dejerine’s sign
derjerine’s sign can be caused by what three SOLs
- herniated or protruding IVD
- spinal cord tumor
- spinal compression fracture
look at the clinical indications of dejerine’s sign on page 77
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during the swallowing test the presence of pain or difficulty swallowing indicates what
- SOL
- ligamentous sprain
- muscular strain
- fracture
- disc protrusion
- tumor
- osteophyte at the anterior portion of the cervical spine
what makes swallowing painful when the swallowing test is positive
it suggests esophageal irritation due to direct trauma or a retroesophageal SOL
doctor stands behind seated patient and occludes the external jugular veins at the level of the clavicles for 10-15 seconds. doctor then asks the patient to cough
naffziger’s test
purpose of naffziger’s test
to create a pooling of the venous sinuses that will cause an increase in cerebral spinal fluid pressure
patient is in a seated position, doctor instructs the patient to rotate the head back and forth as fast as they can. if at any time the patient experiences symptoms the test is considered positive
barre-lieou test
purpose of the barre-lieou test
to rule out vascular insufficiency, cervicogenic vertigo, and possible vestibular apparatus abnormality
patient is supine they rotate and extend their head and count backwards from 20
dekleyn’s test
purpose of dekleyn’s test
to rule out vascular insufficiency
if dekleyn’s test is positive when head is rotated to the right and extended, which vertebral artery is compormised (buckled)
the right vertebral artery
with the patient seated, the doctor exerts upward pressure on the patients head
distraction test
what does generalized, increased pain indicate during the distraction test
muscle spasm
what does relief of pain indicate during the distraction test
IVF encroachment or facet capsulitis
purpose of the distraction test
to confirm IVF encroachment
patient, seated, actively rotates head side to side. the doctor then exerts strong downward pressure with the head in the neutral position, noting any radicular pain. the doctor then rotates the patients head while exerting strong downward pressure
foraminal compression test
purpose of the foraminal compression test
to confirm IVF encroachment and nerve root involvement
if localized pain is solicited during the foraminal compression test what is indicated
foraminal encroachment
if radicular pain is solicited during the foraminal compression test what is indicated
pressure on the nerve root and neurologic level must be evaluated
patient seated, patient actively rotates the head from side to side. note pain. patient then actively laterally flexes the head from side to side. note pain. doctor then exerts strong downward pressure with the head in the neutral position. note pain. doctor then laterally flexes the patient’s head while exerting strong downward pressure. note pain. pressure should be maintained for 30-60 seconds
jackson compression test
purpose of jackson compression test
to confirm IVF encroachment and nerve root involvement
if there is pain on the opposite side of rotation during jackson compression test, what does that indicate
muscular strain
if there is pain on the same side of rotation during jackson compression test, what does that indicate
facet or nerve root involvement
patient seated, then instructed to approximate the chin to the shoulder (fully rotating the head) flex and then extend the neck.
maximum cervical compression test
if pain on the concave side during the maximum cervical compression test, what does that indicate
nerve root or facet involvement (IVF encroachment)
if there is pain on the convex side during the maximum cervical compression test, what does that indicate
muscular strain
jackson’s compression test + a blow to the top of the head
spurling’s test
patient seated, the doctor instructs them to drop their chin to their chest. the doctor then passively flexes the patients head
Lhermitte’s test
purpose of the Lhermitte’s test
traction the posterior column of the spinal cord
what is a positive Lhermitte’s test
when an electric shock like sensation radiating down the neck and spine. this is a sign of posterior column disease and a classic sign of MS
a positive test shows the classic sign for MS
Lhermitte’s test
while patient is sitting, cervical spine is actively moved through range of motion, then through passive range of motion, then through resisted range of motion
O’Donoghue maneuver
purpose of the O’Donogue maneuver
to stress the musculature involved in the motino of the joint being tested
pain during resisted range of motion during the O’Donogue maneuver indicates what
muscle strain
pain during passive range of mostion during the O’Donogue maneuver indicates what
ligamentous sprain
that patient is supine and the doctor passively flexes the patient’s head. the sign is present if flexion of both knees occurs
brudzinski part of the kernig/brudzinski sign
when a positive brudzinski’s sign (both knees flex) what is indicated
meningitis
the patient is supine and the doctor flexes hip and knee of either leg to 90 degrees respectively. doctor attempts to completely extend the leg
kernig part of the kernig/brudzinski sign
when a positive kernig’s sign (opposite knee flexes) what is indicated
meningitis
patient is seated and doctor stands behind and lateral to the mid-line of the side being tested. doctor laterally flexes the head away and while stabilizing the head an inferior force is placed on the ipsilateral shoulder
shoulder depression test
purpose of the shoulder depression test
traction the brachial plexus and its nerve roots, cervical spine, and shoulder complex
radicular symptoms solicited by the shoulder depression test are caused by what
- fibrosis in the IVF
- adhesions to the dural sleeve
- tractioning the nerve root across osteophytes
- edema or compression of the nerve root at the IVF
radiating symptoms solicited by the shoulder depression test are caused by what
- tractioning the nerves across a cervical rib
- soft tissue inolvement
with patient supine the doctor places one hand on the sternum and exerts slight pressure so that no flexion can take place at either the lumbar or thoracic regions of the spine. the doctor places the other hand under the patient’s occiput and passively flexes the head toward the chest
soto-hall test
when is the soto-hall test primarily employed
when a vertebral fracture is suspected
this procedure produces a progressive pull on the posterior spinous ligaments starting at the ligamentum nuchae above and being transmitted downward to the interspinous ligaments until it reaches the spinous process of the involved vertebra where it acts as a lever compressing the body and producing pain
soto-hall test
during soto-hall test when localized dull or sharp pain in the cervical spine is solicited what may radiate to the thoracic spine may be caused by what
- sprain/strain
- avulsion fracture
- facet involvement
- a sharp accentuation of pain with radiculopathy suggests a possible SOL
