Cervical Tests Flashcards
Naffziger’s Test Procedure
Patient is seated; doctor is standing behind the patient. Bilateral digital pressure is placed on jugular veins to occlude their flow for up to 1 minute. Patient is asked to cough deeply
Naffziger’s Test Pathomechanics/Pathophysiology
Jugular veins are venous drainage for the head. Therefore it is the drainage for the CSF. If you stop the flow of venous drainage, you stop CSF drainage & increase the volume of CSF in the subarachnoid space, thus putting pressure on the pia mater & therefore on the spinal cord, also the pressure expands the dura mater in the spinal canal, the coughing at the end increases intra abdominal and intra thoracic pressure and causes contraction of the spinal muscles. This causes an increase in intra discal pressure.
Naffziger’s Test Indications
Aggravation of cord symptoms indicates a SOL within the dura mater, local or radiating spinal symptoms indicates an extra dural SOL
Valsalva’s Maneuver: Procedure
Patient is seated. Examiner instructs the patient to take a deep breath. Have patient hold the breath, and bear down.
Valsalva’s Maneuver: Pathomechanics/Pathophysiology
When you take a big deep breath in and hold it, you slow your heart rate down, therefore slowing down venous return and increasing the volume and pressure in subarachnoid space. Bearing down of the patient increases intraabdominal and intrathoracic pressure and contracts the spinal muscles. This will increase the pressure within the IVD.
Valsalva’s Maneuver: Indications
Cord symptoms indicate intra dural SOL. Spinal pains that may radiate down the extremities may suggest a space-occupying lesion in the spinal canal, such as an IVD protrusion, trauma, and vascular injury causing a hematoma.
Dejernine’s Sign/Triad: Procedure
Patient coughs, sneezes, and strains (bearing down), can be performed or ask about historically
Dejernine’s Sign/Triad: Pathomechanics
Momentarily increases the volume of CSF in the subarachnoid space, and therefore CSF pressure, compressing the cord and making the dura mater expand, also causes intra thoracic and abdominal pressure with spinal muscle contraction increasing intradiscal pressure
Dejernine’s Sign/Triad: Indications
Reproduction of cord symptoms indicates a space-occupying lesion in the cord, symptoms locally and radiating into the extremity indicates spinal canal SOL.
Swallowing Test: Procedure
Ask patient if they have had any problems swallowing food, drink, etc. Or have the patient drink a small amount of fluids
Swallowing Test: Pathomechanics
CN IX & X innervate the muscles that operate the swallowing mechanism moving food or drink into the esophagus. Pathology to the CN IX & X causes the swallowing mechanism to not work. SOL around the esophagus causes difficulty in passing the food or drink down the esophagus
Swallowing Test: Indications
Patient has non-painful inability to swallow indicates CN IX and X pathology. Difficulty swallowing indicates some type of mass around the esophagus.
Barre-Lieou Sign: Procedure
Patient is seated. Instruct the patient to rotate head all the way in one direction, and then all the way in the other direction, and then back too neutral.
Barre-Lieou Sign: Pathomechanics
When the patient is in rotation, the contralateral vertebral artery is compressed and occluded in the transverse foramen of C1; therefore the other arteries supplying the circle of Willis are being tested for cardiovascular disease
Barre-Lieou Sign: Indications
Lightheadedness, nausea, vertigo, hearing and visual disturbances occurring with the head rotated will indicate occlusion of the vertebral and internal carotid arteries. If symptoms occur, you must due one or both of the following tests
DeKleyn’s Test: Procedure
Patient is supine, so that the head is off the end of the table that is being used. Patient hyperextends neck and rotates to one side, hold 15-45 seconds, while keeping eyes open and fixed on a point
DeKleyn’s Test: Pathomechanics
When the patient is in rotation, the contralateral vertebral artery is compressed and occluded in the transverse foramen of C1; therefore the other arteries supplying the circle of Willis are being tested for cardiovascular disease
DeKleyn’s Test: Indications
Lightheadedness, nausea, vertigo, hearing and visual disturbances, nystagmus (horizontal fluttering of eye), occurring with the head rotated will indicate occlusion of the internal carotids and the ipsilateral vertebral artery.
Maigne’s Test: Procedure
Patient is seated. Patient hyperextends the head and rotates
Maigne’s Test: Pathomechanics
When the patient is in rotation, the contralateral vertebral artery is compressed and occluded in the transverse foramen of C1; therefore the other arteries supplying the circle of Willis are being tested for cardiovascular disease.
Maigne’s Test: Indications
Lightheadedness, nausea, vertigo, hearing and visual disturbances, nystagmus (horizontal fluttering of eye), occurring with the head rotated will indicate occlusion of the internal carotids and the ipsilateral vertebral artery
Rust Sign: Procedure
Visualizing the patient, grasping their head as to distract the neck while weight bearing or arising from a recumbent position
Rust Sign: Pathomechanics
This mechanism relieves the compression force of the head on the neck.
Rust Sign: Indication
Cervical spine fracture or severe sprain/strain
Soto-Hall Test: Procedure
Patient is supine. Doctor stands along side the patient and places knife edge of one hand over the sternum (for women patients, have them put their hands over their sternum first). The other hand goes underneath the back of the patient’s head. Doctor passively flexes the head, chin to the chest
Soto-Hall Test: Pathomechanics
Stretching of the posterior neck & upper thoracics, with gapping of the facets. Also compression of the anterior neck
Soto-Hall Test: Indications
Reproduction of symptoms of muscles, ligaments, or bony structure of the posterior spine would indicate sprains, strains, or fractures. Relieving symptoms suggests facet surfaces are causing the pain. Reproduction of symptoms along the anterolateral neck & radiating may compress nerve roots from things such as disc lesions, von luska joint arthrosis, or spondylosis
O’Donoghue’s Maneuver: Procedures
Patient is seated. Passively do all cervical ROM, denoting any symptomatology with localizing and characterizing. In neutral, perform isometric resistive contractions of the cervical spine in all ROMs
O’Donoghue’s Maneuver: Pathomechanics
When performing passive ROM to end play, stretching occurs on the contralateral side and compression occurs on the side of passive motion. Resistive Testing muscles on the ipsilateral side, therefore contracting the muscle is in direction of isometric contraction.
O’Donoghue’s Maneuver: Indications
Ligament symptomatology will be deep and pinpoint upon passive ROM along the contralateral side, indicating a sprain. Muscle symptomatology will be noted with isometric contraction, indicating a strain
L’hermittes Sign: Procedure
Passive flexion of patient’s head to chest
L’hermitte’s Sign: Pathomechanics
Stretches dura mater attached to Foramen Magnum and the Atlas, which stretches the spinal cord cephalid
L’hermitte’s Sign: Indications
Tingling, numbness (paresthesias) or lightning like pain in the upper and lower extremities is the indicator that makes this L’hermittes sign, indicating multiple sclerosis. Radiating pains up and down the spine indicates Myelopathy or meningitis (meningeal irritation).
Brachial Plexus Tension Test: Procedure
Patient seated. Examiner stands behind the patient, asks the patient to place their hands behind their head, then grasps the elbows and extension the elbows back
Brachial Plexus Tension Test: Pathomechanics
This is supposed to place a stretch on the brachial plexus and therefore the nerve roots, as they are pulled through the IVF’s, mainly C4-6. It mainly stretches the pectoralis muscle
Brachial Plexus Tension Test: Indications
Anterolateral neck pain and/or radiating neck pain into the brachial plexus indicate nerve root lesions
Brachial Plexus Stretch Test: Procedure
Patient is seated. Patient’s arm will be abducted as far as it can, externally rotated and extended as far as it can. Patient will rotate the head away from the side being tested, and laterally flexed from the side being tested.
Brachial Plexus Stretch Test: Pathomechanics
Procedure stretches the brachial plexus and nerve roots
Brachial Plexus Stretch Test: Indications
Anterolateral neck pain and/or radiating neck pain into the brachial plexus and down the arm indicate nerve root lesions
Shoulder Depression Test: Procedure
Patient is seated and lateral flexes the head away from the side being tested. The doctor stands behind the patient on the side being test and places his medial hand on the head to stabilize it. Then places his lateral hand on top of the shoulder on the side being tested and depress the shoulder
Shoulder Depression Test: Pathomechanics
Procedure stretches the lateral neck and shoulder, therefore the brachial plexus and nerve roots. This is going to stretch the musculature also.
Shoulder Depression Test: Indications
Anterolateral neck pain and/or radiating neck pain into the brachial plexus and possibly down through the arm, indicative of nerve root lesions. Superficial stretching pains indicate the musculature
Foraminal Compression Test: Procedure
Patient is seated. Doctor rotates patient’s head to the side being tested. Doctor will place both his hands on top of the head and exerts a strong compressive force. After rotations have been done, perform the test in neutral. (Total of 3 parts)
Foraminal Compression Test: Pathomechanics
Compression and rotation to the side being tested narrows the IVF and compresses neural components. Also the facets are imbricated in rotation and therefore on the side being tested, the facets are also being compressed. On the contralateral side, you are stretching muscles and the joint capsules.
Foraminal Compression Test: Indications
Anterolateral neck pain and/or radiating nerve pain on side being tested, nerve roots; posterolateral pain is a facet joint surface. Contralateral side producing superficial pain is muscle stretching and posterolateral deep pinpoint pain is a facet joint capsule
Jackson’s Compression Test: Procedure
Patient is seated. Doctor will laterally flex the patient to the side being tested, and with both hands on top of head, exert a strong downward compression
Jackson’s Compressions Test: Pathomechanics
Laterally flexion will narrow the IVF, compressing the nerve root; also the facets are imbricated and compressed. Downward pressure will increase the internal pressure of the IVD. On the contralateral side you are stretching muscles, ligaments, making the IVF larger
Jackson’s Compression Test: Indications
Ipsilateral neck pain and/or radiating pain, nerve root, and posterolateral is facets. Contralateral symptoms producing generalized pain or symptoms (muscles), pinpoint posterolateral is facet joint surface
Spurling’s Test: Procedure
Patient seated. Doctor will rotate, lateral flex and extend the patient’s head toward the side being tested with downward force. If you do not reproduce the patient’s symptoms, then take hand place on the patient’s head in neutral, and bonk them on the head. If still no symptoms then rotate, laterally flex, extend and then bonk them on the head
Spurling’s Test: Pathomechanics
Same as Jackson’s, except the downward strike on the head is adding a greater increase in momentary compression to the IVD.
Spurling’s Test: Indications
Ipsilateral neck pain and/or radiating pain, nerve root, and posterolateral is facets. Contralateral symptoms producing generalized pain or symptoms (muscles), pinpoint posterolateral is facet joint surface
Bakody’s Sign: Procedure
Patient puts their hand on top of head
Bakody’s Sign: Pathomechanics
This relieves the stretch of the nerve roots by relaxing the tension on the brachial plexus with the arm hanging to the patient’s side
Bakody’s Sign: Indications
Relief of anterolateral neck symptom, radiating symptoms in the anterior shoulder to the arm indicates a nerve root lesion
Distraction Test: Procedure
Patient is seated. Place one hand (palm) under the patient’s chin, the thumb web of other hand back underneath the occiput. Lift head straight up, enough to sit the patient up. Other possible way: Use thenar/hypothenar of both hands underneath the mastoids and distract straight up
Distraction Test: Pathomechanics
Lifting the head and distracting the spine, thus making the spinal canal larger, the IVF’s larger, and separating the facet joint surfaces apart. It also stretches all the cervical spine ligaments
Distraction Test: Indications
Relief of anterolateral and radiating symptoms = Nerve Root. Relief of posterolateral symptoms = Facet joint surface problem. Aggravation of local posterolateral = Joint Capsule
Tests that assess if you have a space occupying lesion, intra or extra durally
Naffziger’s Test, Valsalva’s Maneuver, Dejernine’s Sign/Triad
Checks to see if the patient can swallow or if the patient has difficulty getting the food or drink down the esophagus to the stomach.
Swallowing Test
Test for occlusion of the vascular supply to the Circle of Willis. (Vertebral artery, Internal Carotid artery
Vertebrobasilar Circulation Signs/Tests; Barre-Lieon sign, DeKleyn’s Test, Maigne’s Test
Assesses for Cervical Fractures, and Severe Strains and Sprains
Rust Sign
Passive cervical flexion maneuver, therefore it will stretch the posterior spinal elements, the contents of the spinal canal, along with the anterior part of the neck being compressed
Soto-Hall Test
Passive & resistive cervical ROM. This is to differentiate a strain from a sprain; trauma must have taken place to determine a strain or sprain.
O’Donoghue Maneuver
Same type of procedure as Soto-Hall. Patient is seated though. Indication is what is different
L’hermittes Sign
Suppose to stretch the brachial plexus, which is attached to the nerve roots. Not a very good test
Brachial Plexus Tension test
This is the better test for stretching the brachial plexus
Brachial Plexus Stretch Test
Also stretches the brachial plexus and nerve roots
Shoulder Depression Test
Assesses nerve root and facet symptoms from compression
Foraminal Compression Test
Lateral Flexion Compression, assesses nerve root and facet symptoms from compression
Jackson’s Compression Test
Relieves nerve root tension
Bakody Sign
Relieves compression symptoms from nerve root and facets, stress ligaments. Distracts the cervical spine
Distraction Test
