The Cervical Spine : ROM testing and Special Tests

Question 1

what is the loose packed position of the neck?

Answer 1

midway between flexion and extension

Question 2

What is the closed packed position of the neck?

Answer 2

Extension

Question 3

When testing elderly patients necks what should you be aware of?

Answer 3

Be careful testing because of the possibilities of osteoarthritic or osteoporotic changes in the cervical spine.

Question 4

What is the one symptom that will stop all testing immidiately until other medical intervention can be provided.

Answer 4

Nystagmus or other vertebrobasilar symptoms( dizziness/tinnitis) during testing STOP

Question 5

If you are testing her clients neck and they develope nystagmus or dizziness or slurred speech or tinnitis then what should you do?

Answer 5

STOP testing right away and urge them to go to the doctor.

Question 6

When Ruling out for the neck what 2 joints and what ROM avaliable at those joints should you test?

Answer 6

Temporomandibular joint opening and closing

Shoulder AF forward flexion and Abduction with over pressure.

Question 7

The vertebral Artery Test test for what?

Answer 7

Tests the vertebral artery for occlusion or compression with the foramen transversarium

Question 8

The VBA test should always be performed if the client has reported what symptoms?

Answer 8

dizziness, tinnitis, nausea, slurred speech or light headedness in their case history.

Question 9

How do you perform a VBA Test and what does a positive result mean?

Answer 9

Client supine
Thera supporting cl head off table
Thera passively ext the c spine followed by ipsi side bending and rotation
Hold for 30 seconds
Positive = nystagmus dizziness, tinnitis, slurred speech, nausea or return of symtoms client originally concerned about

Repeat bilaterally

Question 10

What other position can the VBA test be performed in? (other then supine)

Answer 10

High seated
Cl should have there eyes closed
Cl flexes shoulders to 90 degrees
Cl then ext and rotates the head to one side
Positive = is if one had ( usually contralateral side ) starts to drop within 30 sec

repeat by laterally

Question 11

If you position a client in the VBA position and they don’t get any of the positives for the test BUT they do have pain locally in there neck or pain radiating down the arm what does that mean?

Answer 11

Local pain = Facet joint irritation

Radiating Pain = Nerve root impingment

Question 12

How do you perform AF functional testing for the neck?

Answer 12

Client is high seated for all ranges

AF : forward flex, ext, lat flex and rot

Question 13

What is something to look out for when the client is performing AF ROM?

Answer 13

Compensatory movements watch to see if the client moves there torso when they should just be moving there necks.

Question 14

What do you perform PR functional Testing for the neck? And what is the normal end feel for the neck?

Answer 14

The client is supine with their head off the end of the table by the therapist the ROM are the same and AF testing and the normal end feel is tissue stretch.

Question 15

True are false the clients ROM will be greater in PR testing then AF.

Answer 15

True! because gravity will act differently on them in one position verses another.

Question 16

How is AR functional testing of the neck performed?

Answer 16

Cl is high seated
Perform all tests at mid to neutral range
Perform most painful movement first

Question 17

How can you be sure when checking resisted flexion in AR testing that the client is not compensating for weak prime movers by substituting SCM?

Answer 17

Have them tuck there chin before resisting flexion.

Question 18

The Compression test determines what?

Answer 18

It determines whether the nerve root is being compressed as it leaves the spine via the neural foramen.

Question 19

How do you perform the compression test? and what is the positive?

Answer 19

Cl is supine neck neutral
axial load is placed on your cl head

Positive = is a reproduction of the neurological symptoms in the clients upper extremity. Referral down a specific nerve root pathway indicates at which segment the dysfunction is occurring.

Question 20

If you do a compression test what does it mean if the pain is radiating verses local?

Answer 20

radiating = nerve compression
local = facet dysfunction

Question 21

The distraction test determines what?

Answer 21

Relieves pain due to narrowing of the neural foramen

Question 22

How do you perform the distraction test?

Answer 22

Follows the compression test
cl is supine
grasp under jaw and occiput or at the mastoid process if the client has jaw or TMJ problems
Distract

Question 23

What does the spurling’s test determine?

Answer 23

Compression of nerves in the neural foramen

Question 24

What is a positive result for the distraction test?

Answer 24

Relief of pain with distraction

Question 25

How do you perform Spurling’s test.

Answer 25

Cl supine
clients head is Ext, side bent, and rotated to the same side
Thera then places axial load on the head which then closes the neural foreman as much as possible

Question 26

What is a positive result for a Spurling’s Test?

Answer 26

A positive is a reoccurrence of your clients neurological signs and symptoms in the upper limb ispsilat

Question 27

Why choose spurling’s test over Compression test?

Answer 27

The Spurlings and compression tests test for the same thing however the spurling’s test is more specific or provoking than the straightforward compression test.

Question 28

What does the Valsalva test test for?

Answer 28

Tests for a space occupying lesion such as a herniated Disc, an osteophyte or a tumour along the spine

Question 29

How do you perform a Valsalva test?

Answer 29

Ask the high seated client to take a breath, hold it and then bear down as it evacuating the bowels or blow into thumb

Question 30

What is the positive for the valsalva test?

Answer 30

By increasing the intrathecal pressure in the spinal column the positive sign of pain or paresthesia will be felt locally in the spine and may travel down the leg(s) if there is a space occupying lesion.

Question 31

What does a swallowing test test for?

Answer 31

indicated space occupying lesion in the the cervical spine that projects anteriorly, a hematoma, infection or tumour

may also indicate spasming of the sternocleidomastoid muscle

Question 32

How do you perform a swallowing test?

Answer 32

Client swallows

Question 33

What is the positive response for the swallowing test?

Answer 33

Test is positive if client has sensation of a lump in the throat.

Question 34

What does tinels sign indicate?

Answer 34

designed to test the nerve roots as they exit the intervertebral foramen indicates a disruption of the continuity of the nerve.

Question 35

How do you perform a tinels sign test?

Answer 35

Thera applies a series of pressure points to the clients slightly contralaterally flexed neck just behind the SCM in the area of the brachial plexsus

Question 36

What is a positive for the tinels sign test?

Answer 36

A positive is reproduction of the clients neurological symptoms in the upper limb

Question 37

What does a lower quadrant test indicate?

Answer 37

Tests the facet joints from C3 to T1 by placing then in a closed packed position

Question 38

How do you perform a lower quadrant test?

Answer 38

Position the neck in VBA test position

cl head off table
thera passively ext the c spine followed by side bending and rotation both ipsilaterally

Question 39

What is the positive for the Lower quadrant test?

Answer 39

Localized pain will be caused by facet dysfunction while radiating pain confirms nerve root irritation.

Question 40

What does the Upper quadrant test test for?

Answer 40

Determines if the atlanto-occipital or the atlanto-axial joints have restrictive patterns

Question 41

How do you perform an upper quadrant test?

Answer 41

Client supine with cervical ext and ipsi lat flex

contralat rot

Question 42

What is a positive sign for the upper quadrant test?

Answer 42

reduced ROM?