The Cervical Spine : ROM testing and Special Tests Flashcards
what is the loose packed position of the neck?
midway between flexion and extension
What is the closed packed position of the neck?
Extension
When testing elderly patients necks what should you be aware of?
Be careful testing because of the possibilities of osteoarthritic or osteoporotic changes in the cervical spine.
What is the one symptom that will stop all testing immidiately until other medical intervention can be provided.
Nystagmus or other vertebrobasilar symptoms( dizziness/tinnitis) during testing STOP
If you are testing her clients neck and they develope nystagmus or dizziness or slurred speech or tinnitis then what should you do?
STOP testing right away and urge them to go to the doctor.
When Ruling out for the neck what 2 joints and what ROM avaliable at those joints should you test?
Temporomandibular joint opening and closing
Shoulder AF forward flexion and Abduction with over pressure.
The vertebral Artery Test test for what?
Tests the vertebral artery for occlusion or compression with the foramen transversarium
The VBA test should always be performed if the client has reported what symptoms?
dizziness, tinnitis, nausea, slurred speech or light headedness in their case history.
How do you perform a VBA Test and what does a positive result mean?
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
What other position can the VBA test be performed in? (other then supine)
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
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?
Local pain = Facet joint irritation
Radiating Pain = Nerve root impingment
How do you perform AF functional testing for the neck?
Client is high seated for all ranges
AF : forward flex, ext, lat flex and rot
What is something to look out for when the client is performing AF ROM?
Compensatory movements watch to see if the client moves there torso when they should just be moving there necks.
What do you perform PR functional Testing for the neck? And what is the normal end feel for the neck?
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.
True are false the clients ROM will be greater in PR testing then AF.
True! because gravity will act differently on them in one position verses another.
How is AR functional testing of the neck performed?
Cl is high seated
Perform all tests at mid to neutral range
Perform most painful movement first
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?
Have them tuck there chin before resisting flexion.
The Compression test determines what?
It determines whether the nerve root is being compressed as it leaves the spine via the neural foramen.
How do you perform the compression test? and what is the positive?
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.
If you do a compression test what does it mean if the pain is radiating verses local?
radiating = nerve compression local = facet dysfunction
The distraction test determines what?
Relieves pain due to narrowing of the neural foramen
How do you perform the distraction test?
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
What does the spurling’s test determine?
Compression of nerves in the neural foramen
What is a positive result for the distraction test?
Relief of pain with distraction
How do you perform Spurling’s test.
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
What is a positive result for a Spurling’s Test?
A positive is a reoccurrence of your clients neurological signs and symptoms in the upper limb ispsilat
Why choose spurling’s test over Compression test?
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.
What does the Valsalva test test for?
Tests for a space occupying lesion such as a herniated Disc, an osteophyte or a tumour along the spine
How do you perform a Valsalva test?
Ask the high seated client to take a breath, hold it and then bear down as it evacuating the bowels or blow into thumb
What is the positive for the valsalva test?
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.
What does a swallowing test test for?
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
How do you perform a swallowing test?
Client swallows
What is the positive response for the swallowing test?
Test is positive if client has sensation of a lump in the throat.
What does tinels sign indicate?
designed to test the nerve roots as they exit the intervertebral foramen indicates a disruption of the continuity of the nerve.
How do you perform a tinels sign test?
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
What is a positive for the tinels sign test?
A positive is reproduction of the clients neurological symptoms in the upper limb
What does a lower quadrant test indicate?
Tests the facet joints from C3 to T1 by placing then in a closed packed position
How do you perform a lower quadrant test?
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
What is the positive for the Lower quadrant test?
Localized pain will be caused by facet dysfunction while radiating pain confirms nerve root irritation.
What does the Upper quadrant test test for?
Determines if the atlanto-occipital or the atlanto-axial joints have restrictive patterns
How do you perform an upper quadrant test?
Client supine with cervical ext and ipsi lat flex
contralat rot
What is a positive sign for the upper quadrant test?
reduced ROM?
