Special Test For Cervical And Thoracic Spine Flashcards
What are cervical Test
- Distraction Test (Pain Relief Test)
- Spurling’s or Foraminal compression test
- Maximal foraminal compression test
- Valsalva
- Shoulder Depression Test
- Vertebral Artery Test
- Jaw Reflex
- Chvostek’s Test
- Brachial Stretch Tests/Upper Limb Tension Tests
- Median Nerve Dominant
- Radial Nerve Dominant
- Ulnar Nerve Dominant
What are Thoracic Test
- Scapular protraction (winging)
- Elevated Arm Stress Test or “Hands-up” (ROOS)
- Costoclavicular test
- Wright’s Hyperabduction test
- Adson’s Test
- Halstead’s (Reverse Adson’s)
Adam’s Sign (Scoliosis)
What region does the Distraction Test and how do you perform it?
Generally the cervical region but can possibly effect the rest of the spine
How to do: Apply traction to the head
* (+) DECREASED pain with distraction * This test opens the IVF relieving pressure on a nerve root by; decreasing pressure on the facet joint; relaxing contracted muscles
What region does the Cervical Compression Test and how do you perform it?
The Cervical region
How to perform it:
Apply downward pressure to the top of the head
* (+) local pain with compression * This test narrows the IVF to exacerbate facet joint symptoms, stenosis, herniation or osteophytes
What region does the Spurlings/ Maximal Compression Test and how do you perform it?
The cervical region
How to perform it:
Have the pt rotate, laterally flex, and extend the neck then compress
○ (+) local pain with compression
○ Concave side pain = nerve root or facet joint pathology
Convex side pain = muscle strain
What region does the Valsalva test and how do you perform it?
Generally the entire spine
○ (+) reproduction of neck or radicular pain
This test indicates a space occupying lesion (E.g. tumor, herniated disc) is present in the cervical canal
Apply internal pressure by holding pressure internally as if you are defecating. But at the same time not allowing yourself to go so your just keeping pressure
What region does the Brachial Special Test and how do you perform it?
Cervical region
Think of how to put the maximum stretch on the nerve in here lies your answer on how to perform it.
○ (+) reproduction of dermatomal pain referral
- Median Nerve Stretch (C5-C8, T1)
Hand Position: Wrist extension, fingers straight, and elbow extended. The arm may be abducted or externally rotated.
Why This Stretches the Nerve:
The median nerve runs down the arm into the palm of the hand, passing through the carpal tunnel in the wrist. Extending the wrist and fingers stretches this nerve because it increases tension along its entire path from the shoulder to the hand.
The nerve passes through the anterior (front) part of the arm, and extending the wrist and elbow creates a pulling force along the length of the nerve, stretching it at multiple points.
When the shoulder is abducted or externally rotated, this further elongates the pathway of the nerve. - Ulnar Nerve Stretch (C8-T1)
Hand Position: Elbow flexion, wrist extension (with or without finger flexion), and shoulder abduction (putting the hand near the ear or the side of the head).
Why This Stretches the Nerve:
The ulnar nerve runs along the medial (inner) side of the arm, passing behind the elbow (the “funny bone”) and down into the ring and little fingers. Bending the elbow while keeping the wrist extended puts tension on the ulnar nerve.
Flexing the elbow closes the angle at the cubital tunnel (near the elbow), where the ulnar nerve is susceptible to compression. When combined with wrist extension, it creates a stretch throughout the course of the nerve from the elbow down into the hand.
Abducting the shoulder adds additional tension to the nerve, stretching it as it courses through the brachial plexus in the upper arm. - Radial Nerve Stretch (C5-C8)
Hand Position: Elbow extension, wrist flexion, and internal rotation of the arm (forearm pronation).
Why This Stretches the Nerve:
The radial nerve runs along the posterior (back) part of the arm and controls the extension of the wrist and fingers. Flexing the wrist while extending the elbow creates a stretch along this nerve.
The nerve winds around the back of the arm (near the triceps) and down into the wrist. Flexing the wrist and extending the elbow together create a pull on the nerve at two major points: the elbow and the wrist.
Pronation (turning the palm down) and internal rotation of the arm put further tension on the nerve pathway, especially at the radial tunnel near the elbow.
What does the Adams Sign test and How do it?
The entire spine generally
How to perform:
- The purpose of the Adam’s forward bend test is detecting structural or functional scoliosis
- The patient takes off his/her t-shirt so that the spine is visible. The patient needs to bend forward, starting at the waist until the back comes in the horizontal plane, with the feet together, arms hanging and the knees in extension. The palms are hold together.
- The examiner stands at the back of the patient and looks along the horizontal plane of the spine, searching for abnormalities of the spinal curve, like increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk.
- Positive = Functional if curve disappears upon bending
- Positive = Structural if curve does not disappear upon bending
○ (+) Structural when Bending makes curve more obvious
(+) Functional, when Bending makes curve go away
* Other Investigations ○ X-Ray is Best to measure Cobb Angle * Treatment ○ Depends on Cobb Angle ○ <25 Degrees, Observe only ○ >25 Degrees, Bracing (many types) also controversial
> 45 Degrees, Surgical Correction (Rods or Spinal Fusion) Due to possible respiratory problems and cosmetically unacceptable
What region does the Elevated Arm Stress Test, or “Hands-up” test (ROOS) How do you do the it?
The thoracic region
How to perform:
* Patient externally rotates the shoulders with the elbows slightly behind the head
* Patient opens and closes her hands slowly for 3 minutes
Positive = pain, heaviness, or profound arm weakness or numbness and tingling of the hand
Indicates = Thoracic outlet syndrome
What region does the Costoclavicular test and how do you do the it?
Thoracice region
How to perform
* Examiner monitors patients radial pulse
* Examiner draws the patients shoulder down and back as the patient assumes a “military” posture
** Positive =** disappearance or diminution of the pulse, or if symptoms are elicited
Indicates = thoracic outlet syndrome, usually subclavian artery being compressed b/t the 1st rib and the clavicle
What region does the Wright’s Hyperabduction test and how do you do the it?
Thoracic Region
How to Perform:
* Examiner monitors radial pulse
* Examiner then elevates patients arm up to 180 degrees
Positive = diminishment of the pulse or provocation of the symptoms
**Indicates = **thoracic outlet syndrome, usually due to compression of subclavian artery and brachial plexus behind the pectoral muscle and under the coracoid process
What region does the Adson’s test or the Halstead’s Test and how do you do the it?
Part 1
Reverse Adson’s Test is the same test as the Halstead’s test T/F?
Thoracic Region
True
How to perform:
Adson’s test
* Examiner abducts the patients arm and palpates the radial pulse
* Patient is instructed to turn his head toward the affected side, extend the neck, and take a deep inhalation
* Positive = disappearance or diminution of the pulse or provocation of symptoms
* Indicates = thoracic outlet syndrome, usually related to tight scalene musculature
Halstead’s (REVERSE ADSON’S)
* Examiner abducts the patients arm and palpates the radial pulse
* Patient is instructed to turn his head AWAY from the affected side, extend the neck, and take a deep inhalation
* Positive = disappearance or diminution of the pulse or provocation of symptoms
* Indicates = thoracic outlet syndrome, usually related to tight
What region does the Vertebral Artery Test and how to perform it
Cervical Region
How to Perform:
Patient supine, examiner passively places the head and neck into extension and side flexion
· Once in this position the examiner rotates the neck to the same side and
holds it for 30 seconds
Positive
o dizziness or nystagmus
Indicates
Vertebral artery compression
What region does the Shoulder Depression Test and how to perform it
Cervical Region
· Examiner side flexes the patient’s head to one side while applying a downward pressure on the opposite shoulder
Positive
o increased pain to either side
· Indicates
o pain to compressed side = compression of nerve roots,
foraminal encroachment (osteophytes)
· Indicates
pain to stretched side = adhesions around the dural sleeves of the nerve on the side being stretched
What region does the Chvostek Test and how to perform it?
Cervical Region
How to perform:
The examiner taps the facial nerve (typically over the masseter muscle, just anterior to the ear at the zygomatic arch).
Positive:
Twitching of the facial muscles (such as the lip, nose, or cheek) on the same side of the face as the tapping.
Indicates:
A positive test indicates facial nerve hyperexcitability, often associated with hypocalcemia (low calcium levels), and can suggest conditions like hypoparathyroidism or tetany.
What region does the Jaw Reflex Test and how to perform it?
Cervical
How to perform: Tap on the jaw
**Postive: if brisk and complete closure or absent of movement means problem in the UMN lesion a test of the trigeminal nerve (cranial nerve V, or CN V).
Palpation (head, neck, traps) - rule out HA/migraine
HA - local pain/tenderness in areas other than the jaw/TMJ joint
Jaw claudication test - r/o temporal arteritis
Open and close the mouth repeatedly. Pain felt in temples instead of jaw may suggest temporal arteritis.
What does the 3 finger test - or 3 knuckles do and how to perfrm it
Less than 2 finger opening, likely TMJ.
ROM/Palpation of joint
Tenderness, Crepitus/Popping, deviation of tracking, pain, restricted ROM
