Cervical Spine

Question 1

What is Cervical Distraction Test?

Answer 1

1. Place one hand under chin and other around occiput
2. Slowly lift patient’s head

Positive -> pain is relieved or decreased

Question 2

What are the findings for cervical distraction test?

Answer 2

• compressed nerve root - relief with neural foramen opening = cervical radiculopathy
• facet joint pathology - decreased when lifted = cervical degenerative joint disease

Question 3

what is spurling’s or foraminal compression test?

Answer 3

Press straight down on head in 3 stages with
both hands – if symptoms produced do not move
to next stage
Stage 1 – head in neutral
Stage 2 – head in extension
Stage 3 – head in extension and rotation

Positive => pain radiates to arm toward head is flexed
during compression

Question 4

what are the finding for spurling’s or foraminal compression test?

Answer 4

• facet joint pathology - narrows IVF to increase pain = cervical degenerative joint disease
• compressed nerve root with compression = cervical radiculopathy

Question 5

what is maximal foraminal compression test

Answer 5

1. Patient extends, laterally flexes and rotates to
   same side
2. Examiner compresses head in this position

Positive => pain radiating to arm

Question 6

what are the findings for maximal foraminal compression test

Answer 6

Concave side pain → nerve root or facet joint
pathology = Cervical degenerative joint disease
Convex side pain → muscle strain

Question 7

what is the valsalva test

Answer 7

Patient holds breath and bears down as if having
a bowel movement

Positive => pain in cervical spine or dermatome related
to cervical spine injury secondary to increased pressure

Question 8

what are the findings for valsalva test

Answer 8

Space occupying lesion (herniated disc, tumour)
is present in cervical canal => Cervical radiculopathy

Question 9

what is the shoulder depression test

Answer 9

Examiner side flexes patient’s head to one side
and applies downward pressure on opposite
shoulder

Positive => increased pain to either side

Question 10

what are the findings for shoulder depression test?

Answer 10

• Pain to compressed side → compression of
  nerve roots OR foraminal encroachment
  (osteophytes)
• Pain to stretched side → adhesions around dural
  sleeves of nerve on stretched side

Question 11

what is the vertebral artery test?

Answer 11

Patient supine, examiner passively places head
and neck into extension and side flexion
Once in position, examiner rotates neck to same
side and holds for 30s

Positive finding => dizziness or nystagmus

Question 12

what are the findings for vertebral artery test?

Answer 12

Vertebral artery compression

Question 13

what is Chvostek’s test?

Answer 13

Testing for CN7 nerve injury that often refers
pain to TMJ
Examiner taps on parotid gland and observe
reaction

Positive => facial muscles twitch due to tapping

Question 14

what are the findings for Chvostek’s test

Answer 14

CN7 palsy or injury
Low blood calcium

Question 15

what is Jaw reflex

Answer 15

Patient gently opens mouth while examiner
places thumb on chin
Examiner uses reflex hammer to tap thumb
Normal reflex is closing of mouth (stretch reflex
of masseter and temporalis muscles)

Positive => absence of hyperactivity; loss of jaw reflex

Question 16

what are the findings for jaw reflex

Answer 16

CN5 injury – if absent
UMN lesion – is brisk

Question 17

what is soto-hall test?

Answer 17

1. Patient lying supine with legs straight
2. Actively flex neck by putting chin to chest

Positive => lightening like pain

Question 18

what are the findings for soto-hall test?

Answer 18

Dural or meningeal irritation in cervical spine

Question 19

what is the Brachial Stretch/Upper Limb Tension Test

Answer 19

ULTT – median nerve dominant => radicular pain to
median nerve distribution C6 and C7
ULTT – radial nerve dominant => radicular pain to
radial nerve distribution C6 and C7
ULTT – ulnar nerve dominant => radicular pain along
ulnar nerve distribution C8 and T1

Question 20

what are the findings for brachial stretch/upper limb tension test?

Answer 20

irritation or compression of nerve roots = cervical radiculopathy

Question 21

what are the special test for Cervical degenerative joint disease (CJD)?

Answer 21

• cervical compression test
• cervical distraction test
• spurling’s or maximal compression test

Question 22

what are the special test for cervical radiculopathy?

Answer 22

• valsalva
• cervical compression test
• cervical distraction test
• brachial stretch test

Question 23

Other conditions that could be that need to be ruled out by doing special test

Answer 23

TMJ syndrome
whiplash