Evaluation of the Lower Cervical Spine

Question 1

What is a right closing pattern of the c-spine?

Answer 1

R lat flex, R rot, extension

Question 2

What is a right opening pattern of the c-spine?

Answer 2

L lat flex, L rot, flexion

Question 3

How do you perform a quadrant test?

Answer 3

combined extension same-side sidebending, and same-side rotation. Therapist monitors for signs of VAI. If no symptoms with motion, can then add compression.

Question 4

What are the 3 atypical types of pain?

Answer 4

1. Recovery pain (when moved part is returned to neutral position after pain-free movement)
2. Release pain (similar to recovery pain, but comes after part is held in overpressure but is then released)
3. Latent pain (happens after test movements are complete, may be gradual or sudden). From inflammation or other processes.

Question 5

True/False. The comparable sign is the same thing as the concordant sign

Answer 5

True

Question 6

What is the difference between comparable and discordant signs?

Answer 6

Comparable: the movement or test that reproduces the patient’s complaint
Discordant: Abnormality that does not reproduce the complaint (unusual pain or lack of motion).

Question 7

What position should the patient be in when performing a gross passive physiological movement evaluation?

Answer 7

supine

Question 8

How do you perform a passive flexion test determining which level is involved?

Answer 8

pt position: supine
therapist position: standing at pt’s head
both hands: stabilize head, use index and long fingers of each hand to reach articular pillars of adjacent segments.
1. Gently flex and assess motion and stopping at 1st point of pain.
2. Move to next level when examiner feels that no further interspinous opening is occurring at that level.

Question 9

How do you perform a passive extension test determining which level is involved?

Answer 9

pt position: supine
therapist position: either standing or sitting behind patient.
both hands: stabilize head, use index fingers to palpate in the interspinous space (or between the lamina) as the cervical spine is extended.
1. Gently extend and assess motion and stopping at 1st point of pain.
2. Move to next level when examiner feels that no further interspinous closing is occurring at that level.

Question 10

How do you perform a passive rotation test determining which level is involved?

Answer 10

pt position: supine
therapist position: either standing or sitting behind patient.
hand 1: Chin cradle grip
hand 2: palpate in interspinous space (or between lamina) as cervical spine is rotated RIGHT for RIGHT-HANDED chin cradle or LEFT for LEFT-HANDED chin cradle.
1. Assessment done as previously.

Question 11

How do you perform a passive side-bending test determining which level is involved?

Answer 11

pt position: supine
therapist position: either standing or sitting behind patient.
hand 1: Chin cradle grip
hand 2: palpating 2nd MCPJ over facet joints of the patient.

Question 12

Look at Passive Accessory Motion Evaluation on page 20.

Answer 12

Most of the stuff is previously described, but just look at it.

Question 13

You can do cervical compression in neutral, flexion, or extension. What must you do before doing it in extension

Answer 13

exclude vertebral artery first.

Question 14

What does Spurling’s test test for? How do you perform Spurling’s test? What is a positive?

Answer 14

Tests for nerve root compression or irritation
pt. position: seated
1. Sidebend head to painful side
2. Add compression, hold for 5 seconds
Positive: arm pain is reproduced ONLY (not just cervical pain).

Question 15

What does the shoulder abduction (relief) test test for?
How do you perform a shoulder abduction test?
What is a positive?

Answer 15

Tests for compression of the C6 nerve root
Pt. position: supine
1. Abduct shoulder with flexed elbow
Positive: upon this movement, symptoms are RELIEVED (this position decreases nerve root tension).

Question 16

You should know how to test traps, serratus anterior and deep ant. cervicals.

Answer 16

If you don’t, check out page 21.

Question 17

You should know how to do ULTT 1 (Median and Radial biases) from Ortho 1.

Answer 17

If you don’t, check or pages 22-23.

Question 18

How do you perform ULTT 2 (Median) on L UE?
ULTT 2 (Radial)

Answer 18

1. Pt. position: DIAGONALLY on table with L shoulder on edge of table.
2. Therapist position: facing caudally (toward feet) at patient’s head
3. Therapist’s R hand supports patient’s elbow while L hand supports patient’s hand and wrist. Patient’s wrist and fingers extended.
4. Pt’s arm is held at approx. 10-30° abd., neutral rot. and 60-90° elbow flex
5. Shoulder depression with therapist’s thigh is performed.
6. While maintaining shoulder depression and 10-30° abduction, shoulder ER and elbow ext. are added
7. Sidebending to the right.
   Radial: Same as above, but arm IR and wrist FLEXED.

Question 19

What is the final position for ULTT 3?

Answer 19

shoulder abd., elbow flex. wrist extension, pronation of forearm (so palm is facing upward).