cervical special tests Flashcards
Sharp-Purser test indications:
MVA or other cervical trauma (can assume + if pt has Down Syndrome or RA)
(Tests for Upper cervical instability; tests integrity of transverse ligament of the the dens)
Sharp-purser test interpretation.
Positive if a clunk is felt
or
there is a reduction in symptoms during test.
(It tests for Upper cervical instability; tests integrity of transverse ligament of the the dens)
Sharp-Purser Implications for positive test
Upper cervical instibility of C1 on C2
Tests integrity of transverse ligament of dens
Alar Ligament (occipital part) test Indications
MVA or other cervical trauma
Can assume it is positive if pt has Down Syndrome or RA
Alar Ligament (occipital part) Method 1 (of 2) technique:
Stabilize C2 and passively laterally flex.
(if ligament is intact (-), then will feel resistance to LF; If ligament unstable (+) then will have soft (or no) end-feel or excessive movement)
Alar Ligament (occipital part) Method 2 (of 2) technique:
Palpate C2 and have patient laterally flex
(If ligament intact (-), sp proc of C2 will move contralaterally; if ligament unstable (+) then C2 won’t move)
Alar Ligament (occipital part) implications of positive test:
Unstable alar ligament (occipital portion) and resultant instability of the dens
What two Cervical special tests are indicated if a patient has MVA or other cervical trauma?
Sharp-Purser
Alar Ligament (occipital part)
Vertebral Artery Test Indications
All patients (especially if planning to do end ROM treatments with them). And especially if they have any of the 5 D’s (Dizziness, diplopia, dysphagia, dysarthria, & drop attacks).
5 D’s
- Dizziness
- diplopia
- dysphagia
- dysarthria
- drop attacks
Diplopia
double vision or blurred vision
dysphagia
problems with swallowing
dysarthria
difficulty speaking
drop attacks
More than one definition it seems but I liked this one: “Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness and the event is remembered.”
Vertebral Artery Test: how to perform
Pt position: supine
Passively fully extend and LF while watching eyes, hold 30s ; if (-) then add rotation towards LF and hold 30 more seconds. The side being tested is the side contralateral to the LF.
Vertebral Artery test: what is a positive test? (includes 5 symptoms)
Positive if following symptoms occur during test:
- dizziness
- nausea
- vertigo
- visual changes
- nystagmus
Sharp-Purser Test: how to perform (quick summary)
Pt position: sitting
Patient slowly flexes neck while exainor provides posterior pressure with hand on forehead and anterior pressure on spinous process of C2. Attempting to apply sheer force to C1-C2.
What special tests could you perform to test disks and Nerve roots? (5)
- Compression test
- Distraction Test
- Spurling Test
- Repeated Protrusion test
- Repeated Retraction test
What special tests did we learn that are McKenzie based? (2)
- Repeated Protrusion
- Repeated Retraction
nystagmus
involuntary rapid eye movements
What special tests might you consider performing on a patient presenting with radicular symptoms? (9)
- Compression test
- Distraction test
- Spurling
- Repeated Protrusion test
- Repeated Retraction test
- ULTT1
- ULTT2
- ULTT3
- ULTT4
Indications for Compression test:
Radicular symptoms
Indications for Distraction test
Radicular symptoms (must be at rest for test to be performed)
Indications for Repeated Protrusion test:
Radicular symptoms
Indications for Repeated Retraction:
Radicular symptoms
Indications for ULTT1 test:
Radicular symptoms
Indications for ULTT2 test:
Radicular symptoms
Indications for ULTT3:
Radicular symptoms
Indications for ULTT4 test:
Radicular symptoms
Compression test; how to perform:
pt position: sitting
Axial compression in neutral position (facing pt preferable)
Distraction test, how to perform:
Pt position: Sitting or Supine
Axial distraction in neutral position
Distraction test in sitting, advantages
sitting is a functional position so it may apply better to daily life
Distraction test in supine, advantages
can get more leverage; easier to apply more force
Spurling test method one, how to perform:
Pt position: sitting
Axial compression with LF toward side of symptoms
Spurling test method 2, how to perform:
pt position: sitting Stepwise:
- Axial compression in neutral (same as compression test)
- Axial compression during extension
- Axial compression during extension and rotation toward affected side
Repeated Protrusion test, execution:
pt position: sitting
protrude head and return to neutral 10 times. Stop when positive even before 10 times