Orthopedic Diagnosis: Cervical Spine

Question 1

Foraminal Compression Test

Answer 1

1. Positive: Exacerbation of localized cervical pain
   
   • Indicates: Foraminal encroachment or facet pathology without nerve root compression
2. Positive: Exacerbation of cervical pain with a radicular component
   
   • Indicates: Foraminal encroachment or facet pathology with nerve root compression

Question 2

Cervical Distraction Test

Answer 2

1. Positive: Diminished of absence of local cervical pain
   
   • Indicates: Foraminal encroachment without nerve root compression
2. Positive: Diminished or absence of radiating pain
   
   • Indicates: Foraminal encroachment with nerve root compression
3. Positive: Increase of cervical pain
   
   • Indicates: Muscular strain, ligamentous sprain, myospasm or facet capsulitis

Question 3

Spinal Percussion Test

Answer 3

1. Positive: Local pain
   
   • Indicates: Possible fractured vertebrae, ligamentous involvement (spinal pain) and muscular involvement (muscular pain)
2. Positive: Radiating pain
   
   • Indicates: Possible disc pathology

Question 4

Shoulder Depression Test

Answer 4

1. Positive: Localized pain on the side being tested
   
   • Indicates: Dural sleeve adhesion and muscular adhesion/contracture, or spasm or ligamentous injury
2. Positive: Radicular pain on either side
   
   1. Radiating pain on side being tested
      
      • Indicates: Neurovascular bundle compression, dural sleeve adhesions or thoracic outlet syndrome
   2. Radiating pain on opposite side being tested
      
      • Indicates: Foraminal encroachment with nerve root compression

Question 5

Valsalva Maneuver

Answer 5

• Positive: Radiating pain from site of the lesion (usually recreating the complaint in the cervical or lumbar area of the spine)
  
  • Indicates: Space occupying lesion (e.g. disc pathology)

Question 6

Swallowing Test

Answer 6

• Positive: Difficulty in swallowing
  
  • Indicates: Space-occupying lesion at the anterior portion of the cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes, etc.

Question 7

Soto-Hall Sign

Answer 7

• Positive: Generalized pain in the cervical region, which may extend down to the level of T2
  
  • Indicates: Non-specific test for structural integrity of cervical region

Question 8

Kernig Sign

Answer 8

• Positive: Inability to fully extend the leg and/or pain (usually in the neck region)
  
  • Indicates: Meningeal irritation/meningitis

Question 9

O’Donoghue Maneuver of the Cervical Spine

Answer 9

1. Positive: Pain during passive range of motion
   
   • Indicates: Ligamentous sprain (passive range of motion stresses ligaments)
2. Positive: Pain during resisted range of motion
   
   • Indicates: Muscle/tendon strain (active range of motion stresses muscles and tendons)

Question 10

Jackson Compression Test

Answer 10

1. Positive: Exacerbation of localized cervical pain
   
   • Indicates: Foraminal encroachment or facet pathology without nerve root pressure
2. Positive: Exacerbation of cervical pain with a radicular component
   
   • Indicates: Foraminal encroachment with nerve root compression

Question 11

Maximal Cervical Compression

Answer 11

• Positive: Pain on the concave side
  
  • Indicates: Foraminal encroachment with or without nerve root compression (based on the presence or absence of a radicular component)

Question 12

Bakody Sign

Answer 12

• Positive: Decrease of absence of radiating pain
  
  • Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/C6 level becuase this motion elevates the suprascapular nerve and relieves traction on the upper brachial plexus)

Question 13

Shoulder Abduction Test

Answer 13

• Positive: Decrease or absence of radiating pain
  
  • Indicates: Cervical foraminal compression, nerve root entrapment (usually C5/C6 level becuase this motion elevates the suprascapular nerve and relieves traction on the upper brachial plexus)

Question 14

Naffziger Test

Answer 14

• Positive: Radicular pain (typically in lumbars, possibly cervical or throacic)
  
  • Indicates: Space occupying lesion