Cervical Spine Special Tests Flashcards
Vertebral Artery Test
PURPOSE- Assesses the integrity of vertebro-basilar vascular system
DESCRIPTION- With the patient supine, the examiner passively takes the patient’s head and neck into extension and side flexion. After this movement is achieved, the examiner rotates the patient’s neck to the same side and holds it for approximately
30 seconds.
RESULT- A positive test provokes referring symptoms if the opposite artery is affected
Hautant’s Test
PURPOSE- Differentiate dizziness or vertigo caused by articular problems from that
caused by vascular problems
DESCRIPTION- The patient sits and forward flexes both arms to 90°.The eyes are then closed. The examiner watches for any loss of arm position. If the arms move, the cause is nonvascular.
The patient is then asked to rotate, or extend and rotate, the neck; this position is held while the eyes are again closed. If wavering of the arms occurs, the dysfunction is caused by vascular impairment to the brain. Each position should be held for 10 to 30 seconds
Transverse Ligament Stress Test
PURPOSE- To test integrity of transverse ligament
DESCRIPTION- The patient lies supine with head supported on the table. Glide C1 anterior. Should be firm end feel. The position is held for 10 to 20 seconds to see whether symptoms occur, indicating a positive test
RESULT- Positive symptoms include soft end feel; muscle spasm; dizziness; nausea; paresthesia of the lip, face, or limb; nystagmus; or a lump sensation in the throat.
Sharp-Purser Test
PURPOSE- To determine subluxation of the atlas on the axis.
DESCRIPTION- The examiner places one hand over the patient’s forehead while the thumb of the other hand is placed over the spinous process of the axis to stabilize it. The patient is asked to slowly flex the head; while this is occurring, the examiner presses backward with the palm.
RESULT- A positive test is indicated if the examiner feels the head slide backward during the movement. The slide backward indicates that the subluxation of the atlas has been reduced, and the slide may be accompanied by a “clunk.”
Anterior Shear Test
PURPOSE- Test the integrity of the supporting ligamentous and capsular tissues of
the cervical spine
DESCRIPTION- The patient lies supine with the head in neutral, resting on the bed. The examiner applies an anteriorly directed force through the posterior arch of C1 or the spinous processes of C2 to T1 or bilaterally through the lamina of each vertebral body. In each case, the normal end feel is tissue stretch with an abrupt stop
RESULT- Positive signs, especially when the upper cervical spine is tested, include nystagmus, pupil changes, dizziness, soft end feel, nausea, facial or lip paresthesia, and a lump sensation in the throat
Foraminal Compression (Spurling’s Test)
PURPOSE- Identifies dysfunction (compression) of cervical nerve root
DESCRIPTION- The patient bends or side flexes the head to the unaffected side first, followed by the affected side. The examiner carefully presses straight down on the head.
RESULT- The dermatome distribution of the pain and altered sensation can give some indication as to which nerve root is involved
Distraction Test
PURPOSE- Identify compression of neural structures at intervertebral foramen or facet joint dysfunction
DESCRIPTION- Patient sitting and distract the head passively
RESULT- Positive finding is decrease in symptom in neck (facet condition) or decrease in upper limb pain (neurological condition)
Shoulder Abduction Test (Bakody’s Test)
PURPOSE- To test for radicular symptoms, especially those involving the C4 or C5 nerve roots.
DESCRIPTION- The patient is sitting or lying down, and the examiner passively or the patient actively elevates the arm through abduction so that the hand or forearm rests on top of the head
RESULT- A decrease in or relief of symptoms indicates a cervical extradural compression problem, such as a herniated disc, epidural vein compression, or nerve root compression, usually in the C4–C5 or C5–C6 area.
Lhermitte Sign
PURPOSE- Identifies dysfunction of spinal cord and upper motor neuron lesion.
DESCRIPTION- The patient is in the long leg sitting position. The examiner passively flexes the patient’s head and one hip simultaneously with the leg kept straight
RESULT- A positive test occurs if there is a sharp, electric shock-like pain down the spine and into the upper or lower limbs; it indicates dural or meningeal irritation in the spine or possible cervical myelopathy.
