Spine Special Tests Flashcards
Describe the position, procedure, and positive findings for the cervical flexion rotation test.
Supine
Fully flex the patient’s cervical spine. Rotate the cervical spine each direction while maintaining flexion. Patient should have ~45 degrees of rotation in each direction.
If patient has limited rotation in this position, the dysfunction is likely at the AA joint. Can also be used as provocative test for cervicogenic headache.
Describe the position, procedure, and positive findings for the distraction test.
Used for patients who are currently experiencing radicular sxs.
Sitting
Place one hand under the patient’s chin and the other hand under the occiput. Apply an upward distraction force.
Positive for cervical nerve root compression if the pain is decreased with the distraction force.
Describe the position, procedure, and positive findings for the foraminal compression test.
Sitting with the head laterally flexed.
Place both hands on top of the subjects head and exert a downward force.
Positive test indicated by pain radiating into the arm toward the flexed side and may be indicative of nerve root compression.
Describe the position, procedure, and positive findings for the vertebral artery test.
Supine
Place patient’s head into extension, lateral flexion and rotation to the ipsilateral side.
Positive test indicated by dizziness, nystagmus, slurred speech or loss of consciousness any may be indicative of compression of the vertebral artery.
Describe the position, procedure, and positive findings for the gapping test.
Supine
Apply pressure in downward and lateral direction to each ASIS.
Positive test indicated by pain in the SI joint, gluteus or posterior leg and may indicate sprain of anterior sacroiliac ligaments.
Describe the position, procedure, and positive findings for the SI joint stress test.
Supine
Cross your arms an place the palms of the hands on the patient’s ASIS. Apply a downward lateral force to the pelvis.
Positive test indicated by unilateral pain in the SI joint or gluteal area, and may be indicative of SI joint dysfunction.
Describe the position, procedure, and positive findings for the sitting flexion test.
Sitting with knees flexed to 90 degrees and the feet on the floor. Hips should be abducted to allow patient to bend forward.
Place thumbs on the PSIS and monitor the movement of the bony structures as the patient bends forward and reaches toward the floor.
Positive test indicated by one PSIS moving farther in the cranial direction and may be indicative of an articular restriction.
Describe the position, procedure, and positive findings for the Slump test.
Sitting at edge of table.
Ask patient to slump and bring their chin towards their chest. Use one hand to maintain the position of full spinal flexion while using the other hand to place the patient’s ankle in full dorsiflexion. Ask the patient to actively extend the knee (can be done passively too).
Positive test for neural tension if sxs decrease with knee extension or the patient can extend the knee farther.
Describe the position, procedure, and positive findings for the standing flexion test.
Standing with feet 12 inches apart.
Place thumbs on inferior margin of PSIS and monitor the movement of the bony structures as the patient bends forward with the knees extended.
Positive test indicated by one PSIS moving farther in a cranial direction and my be indicative of an articular restriction.
Describe the position, procedure, and positive findings for the SLR test.
Supine.
Flex the patient’s hip while maintaining knee extension an slight medial rotation of the hip. Flex the hip until the patient complains of pain or tightness in the low back or posterior leg. Lower the leg until the patient feels no pain or tightness. At this point, dorsiflex the ankle (or have patient flex the neck).
If sxs return, the test is positive for neural tension or a lesion within the spinal cord (i.e. spinal herniation)
Describe the position, procedure, and positive findings for Lhermitte’s sign.
Long sitting on table.
Passively flex the patient’s head and one hip, while keeping the knee in extension.
Positive test indicated by “electrical” pain down the spine and into the UE or LE. May indicate presence of UMN lesion or spinal cord lesion.
Describe the position, procedure, and positive findings for the Alar ligament test.
Sitting.
Passively flex the neck slightly and apply a firm pincer grip to the C2 spinous process. Palpate movement at C2 during passive upper cervical side bending or rotation.
Positive test indicated by inability to palpate C2 moving in conjunction with C1.
Describe the position, procedure, and positive findings for Modified Sharp purser test.
Sitting.
Passively flex the neck slightly and apply a firm pincer grip to the C2 spinous process. Apply a posterior translation and extension force to the forehead while assessing for excessive linear translation or reproduction of myelopathic symptoms.
Positive test indicated by myelopathic sxs with upper cervical flexion or a decrease in sxs or excessive translation during the posterior translation. May indicate transverse ligament/atlantoaxial instability.
Describe the position, procedure, and positive findings for femoral nerve traction test
Sidelying on non-painful side. Trunk in neutral, head flexed slightly with lower leg hip and knee flexed.
Passively extend the hip while the knee of the painful hip is in extension. If no reproduction of sxs, flex knee of painful leg.
Positive test indicated by neurological pain in anterior thigh. May indicated compression of the femoral nerve anywhere along its course.
Describe the position, procedure, and positive findings for the Valsalva maneuver.
Sitting
Instruct the patient to take a deep breath and hold while they “bear down” as if having a bowel movement.
Positive findings indicated by increased LBP or neurological sxs into LEs. May indicated the presence of a space-occupying lesion.
