Cx Spine

Question 1

Spurlings

Answer 1

o Overpressure in neutral / +SB Left / +SB Right
o Local pain indicates facet Jt involvement
o Radicular pain indicates nerve root impingement

Question 2

Quadrant

Answer 2

o Overpressure in flexion/extension with SB+Rotn L + R
o Local pain indicates facet Jt involvement
o Radicular pain indicates nerve root impingement

Question 3

Soto-Hall

Answer 3

o Pt supine, passive flexion of PT neck with stablisation at sternum
o Local pain indicates ligament / Mm / boney pathology
o Radicular SSx indicate disc pathology

Question 4

Percussion Test

Answer 4

o Pt seated in light flexion, percuss Cx SPs with reflex hammer
o Local pain- vertebral # without neurological compromise
o Radicular pain- vertebral # or disc pathology with neuro compromise → Also potential for ligamentous sprain to elicit local pain

Question 5

Distraction Test

Answer 5

o Pt seated, grasp beneath mastoid and traction head / neck
o If local pain INCREASES suspect Mm strain, spasm, ligament or capsule sprain
o If radicular pain DECREASES indicates either disc pathology or foraminal stenosis

Question 6

Transverse Lig

Answer 6

o Pt seated, fix over arch of C2 and apply posterior pressure with arm over forehead
o Familiar pain / neurological SSx or excessive movement indicate ligamentous laxity / Upper Cx Instability

Question 7

Alar Lig

Answer 7

o All tests performed with Pt seated and supine
o All tests performed in neutral, flexion and extension
o To test SB, fix over posterior arch of C2 and apply slight overpressure in direction being tested → no excessive movement should be observed
o To test rotation fix over posterior arch of C2 and apply slight overpressure with crook of arm in direction being tested → normal movement 20-40 deg.
o Note: a positive finding general requires findings in both seated and supine positions (also some argument as to whether findings need to be bilateral or if unilateral qualifies).