Lecture 3 - Cervical Ortho's Flashcards
patient places the palm of the affected arm on the top of their head, raising the elbow to about the level of the head
positive sign is =
Bakody’s sign
positive = decrease in limb pain
nerve root irritation
the seated patients arm is held up and back, with the elbow flexed. the elbow is then extended
positive sign =
Bikele’s sign
positive = increase/provoke pain with root syndromes or TOS
seated patient abducts the arms fully, then externally rotates them. they then flex their elbows to place the backs of their hands against the back of their head
positive sign =
brachial plexus tension test
positive = exacerbation/reproduction of pain may be indicative of a root lesion, typically C5
exacerbation/provocation of radicular pain during sneezing, coughing, or straining during a bowel movement
Dejerine’s Triad
examiner applies traction to the seated patients head, typically via a hand contact under the mastoids
positive =
Cervical distraction
positive = increased in pain indicated strain, decrease in arm symptoms may indicated root lesion, decrease in local neck pain may indicate facet synovitis/compression
Doc exerts downward pressure on the top of the patients head in
- neutral
- extension
- right and left rotation
- right and left lateral flexion (aka ____ test)
- positive sign =
Cervical compression tests
- neutral = disc and body
- extension = facet, close IVF
- rotation = ipsilateral foramen / root
- lateral = ipsilateral foramen / root
positive = local pain is facet in origin, radicular pain is root lesion
seated patients head is passively flexed
positive sign =
L’Hermitte’s test
positive = pain or paresthesia radiating down the spine or into the limbs; indicates cervical myelopathy
V1: seated patient rotates and extends the head toward the side of pain
V2: seated patient laterally flexes to the side of pain and then rotates to the same side
Maximum cervical compression test
- each aim to close down the IVF
- positive = local pain is facet lesion, radiating pain is root, scalene pain is TOS
patient seated, doc occludes the external jugular veins with a digital or index contact
positive sign =
Naffziger’s test
- swells the dura, pressure increases, + means disc but no level indicated
positive = local pain or any change in patients symptoms indicates spinal lesion, typically SOL
seated patient first goes through active resisted ROM, isometric contraction, then passive ROM
- positive signs =
O’Donoghue Maneuver
positive =
- pain during active ROM = strain
- pain during passive ROM = sprain
NOT A GREAT TEST
seated patient will hold on to the head with both hands, patient will support the head during seated supine transitions
positive =
Rust’s sign
positive = sign of instability, fracture, severe strain/sprain
neck hurts (whiplash)
patient seated, doc laterall flexes the head away from the side of pain, then depresses the shoulder
positive =
Shoulder depression test
positive = local pain is myofascial/strain-sprain, radicular pain is root lesion via stretch injury or inflammation
patient supine, doc stabilizes the patient’s sternum with one hand, while flexing the neck with the other
positive =
Soto-Hall
positive = local pain is fracture, sprain/strain, radicular pain is root lesion, reflex flexion of the hips and knees is Brudzinski’s sign of meningitis
POOR TEST
patient seated with head/neck flexed, doc percusses the SP’s and paraspinal soft tissues with a reflex hammer
positive signs =
Spinous percussion
positives = local pain is fracture, mets, infection; local soft tissue pain is trigger points, strain; radicular pain is disc/root lesion
V1: patient seated, laterally flex head to side of complaint, then apply pressure on top of the head, if symptoms do not reproduce… extend the neck
V2: patient seated, laterally flex head to side of complaint, then use percussion
Spurling’s test
positive = local pain is facet lesion, radicular pain is root lesion
