Cervical Spine Exam

Question 1

Neck Disability Index

Answer 1

Higher Score = Greater disability
Specific to Function
MCID > 10

Question 2

Fear Avoidance Belief Questionnaire (FABQ)

Answer 2

fear avoidance about physical activity at work or activities
high work > 34
high activity >14

Question 3

Tampa Scale of Kinesiophobia (TSK)

Answer 3

assess fear of movement
> 37 indicates fear

Question 4

CLEAR C SPINE - Symptoms & Signs

Answer 4

5 D’s And 3 N’s:
-Dizzy
-Dysarthria
-Dysphagia
-Drop attacks
-Diplopia
-Ataxia
-Nystagmus
-Numbness
-Nausea

also bladder/bowel dysfunction, malaise, memory impairments, etc

Question 5

Canadian C-Spine Fracture Rules: High Risk

Answer 5

Age > 65
Dangerous Mechanism
Extremity Paresthesia (pins/needles)

YES -> CT scan
No -> low risk

Question 6

Canadian C-Spine Fracture Rules: Low Risk

Answer 6

Simple rear-end MVA
Patient can sit in ED
Can walk after
No midline c-spine tenderness
Delayed onset of neck pain

YES -> see if they can actively rotate neck 45 deg…. (if not, CT scan, if they can then they do not need imaging)

No -> CT Scan

Question 7

Sharp-Purser Test (transverse ligament)

Answer 7

(+) if cervical flexion brings myelopathy symptoms (5 Ds And 3Ns)
AND
if AP shift of C2 reduces symptoms

Question 8

Alar Ligament Stress Test

Answer 8

(+) if no movement is felt by PT while having pincer grip on C2 spinous process

Question 9

Vertebral Basilar Artery Testing

Answer 9

cervical end-range extension & then rotated & extended for 15-30sec
If (+) 5 Ds And 3 Ns

Question 10

Muscle Performance: Cranial Cervical Flexion Test

Answer 10

Perform cranial flexion in increments of 22, 24, 26, 28, and 30 on blood pressure cuff

test ends when unable to hold for 10 sec or drops below 20mmHg

Question 11

Muscle Performance: Anterior Neck Flexor Endurance Test

Answer 11

Retract (chin & neck wrinkles!) and hold neck 1 inch off table. Test ends when can no longer hold up or come out of retraction

Question 12

Muscle Performance: Posterior Neck Extensor Endurance Test

Answer 12

Prone, head off table
Stabilize at T2-T4
Chin tuck

Question 13

Upper Trap Muscle Length Testing

Answer 13

Contra Side bend
Extension
Ipsilateral Rotation

O:Occiput
I: Spine of Scapula

Question 14

Levator Scapulae Muscle Length Testing

Answer 14

Contra Side bend
Flexion
Contra Rotation

Looks like your sniffing your own armpit
O: superior angle of scapula
I: medial border of scapula

Question 15

Sternocleidomastoid Muscle Length Testing

Answer 15

Extension
Contra Side bend
Ipsilateral rotation

O: Sternum, clavicle
I: Mastoid process

Question 16

Scalenes Muscle Length Testing

Answer 16

Extension
Contra Side bend
Ipsilateral Rotation

O: transverse processes of C2-C7
I: 1st & 2nd Rib

Question 17

Spurling’s Test

Answer 17

-For cervical radiculopathy due to compression
-Side bend neck to involved side & compress (to reduce transverse foramen space)

(+) = reproduces concordant pain

Question 18

Cervical Distraction Test

Answer 18

-For cervical radic
Maximizes transverse foramina space

(+) = reduced/eliminated radicular symptoms

Question 19

Upper Limb Tension Test (ULTT)

Answer 19

For (+), it must:
-reproduce concordant pain
-difference from involved vs uninvolved
-symptoms sensitized both proximally & distally

Question 20

Median Nerve ULTT A/1

Answer 20

Shoulder Depression
Elbow Extension
Forearm Supination
Wrist Extension
Finger + Thumb Extension
Contra Cervical Side Bend (away= symptoms increase, towards= symptoms decrease)

Question 21

Radial Nerve ULTT B/2

Answer 21

Shoulder Depression & ABD
Elbow Extension
Forearm Pronation
Wrist Flexion
Finger + Thumb Flexion
Contra Cervical Side Bend

Question 22

Ulnar Nerve ULTT C/3

Answer 22

Shoulder Depression & ABD
Elbow Flexion
Forearm Pronation
Wrist Extension/Radial Deviation
Finger + Thumb Extension
Contra Cervical Side Bend

Question 23

Valsalva Maneuver

Answer 23

-For Cervical Radic
-Hold breath & bear down (or sneezing, coughing, straining)
(+) = reproduction of concordant pain

Question 24

Cervical Flexion Rotation Test

Answer 24

-For Cervicogenic Headaches
-Fully Flex Cervical Spine
-Rotate right & left
->45 deg
(+) = provocation of pain & loss of 10 deg or more

Question 25

Roos Test

Answer 25

-For Thoracic Outlet
Patient sits, abducts and ER shoulder to 90 deg & flexes elbows, opening/closing hands every 2-3 sec. Do until 3 min or patient can no longer do
(+) = reproduction of symptoms: ischemic pain, arm heaviness, profound weakness, numb/tingly

Question 26

Adson’s Test

Answer 26

-For Thoracic Outlet
-arm ABD to 30 deg with shoulder maximally extended
-palpate radial pulse
-extends neck & turns head to symptomatic shoulder and takes deep breath

(+) = marked decrease or loss of pulse