Upper Cervical Screen

Question 1

What 3 things are you looking for in a upper cervical spine screen in observation in sitting?

Answer 1

1. Look for rigid holding pattern
2. neck rotation “cock robin” posture
3. Symmetry of eyes/face

Question 2

What 3 things are you looking for in a upper cervical spine screen in observation in standing/gait?

Answer 2

1. Unsteadiness
2. Postural Sway
3. Ataxia

Question 3

How do you test the cranial nerves according to our notes? Go through them…

Answer 3

I: Identify familiar smells
II: Visual Fields
III: Reaction to Light
IV: Downward & Lateral Gaze
V: Face sensation, teeth clenching
VI: Lateral Gaze
VII: Close eyes tight, puff Cheeks
VIII: Hearing
IX: Ability to swallow
X: Say "Ahhh"
XI: Resisted shoulder shrug
XII: Tongue protrustion (deviates to injured side)

Question 4

How do you perform a Hoffman’s test?

Answer 4

1. Tell pt. to relax fingers
2. Stabilize distal phalanx (do NOT stabilize thumb and index fingers)
3. Grab with thumb and index finger
4. Move thumb downward till your nail “clicks” over the end of the pt’s nail.
5. Also flick it
6. Flick and click bilat. 3-5x each side.

Question 5

What is a positive Hoffman’s test?

Answer 5

When thumb and index finger flex after flick/click.

Question 6

Is the knee straight or bent during clonus testing and how many twitches of PF’s is required to be a positive test?

Answer 6

knee straight

4-5 reflex twitches

Question 7

What ligament does the sharp-purser test test?

Answer 7

transverse ligament

Question 8

How do you perform a sharp-purser test?

Answer 8

pt position: sitting with head flexed slightly
hand 1: Spinous process of C2 stabilized with pincer or key grip.
hand 2: palmar pressure on forehead to translate head and C1 post.
negative: no movement
positive: movement or symptom relief

Question 9

How do you perform an Alar Ligament Test?

Answer 9

pt position: sitting or supine
hand 1: sidebending pt’s neck
hand 2: palpating C2 spinous process
negative: spinous process moving AWAY from the direction of the lateral flexion.
positive: no movement or increased symptoms.

Question 10

How do you perform a Transverse Ligament of Atlas Test?

Answer 10

pt position: supine
hand 1 & 2: supporting head with both palms on pt’s occiput and fingers along arch and transverse process of C1. ANT. force with fingers and gently lifting head
negative: no movement.
If no symptom reproduction after 15-20 s,
then use shoulder to apply post. force to
forehead of patient.
positive: increased motion or cardinal/neuro symptom reproduction

Question 11

If a positive is found in either the sharp purser, alar ligament, or transverse ligament of atlas tests, what do you do next?

Answer 11

Pt. placed in cervical collar
referred for medical treatment immediately
If in doubt, refer them out

Question 12

How do you perform the 1st test for VAI?

Answer 12

pt. position: sitting
Stage 1: Have pt. turn head, count out loud for 10 seconds while therapist monitors dysarthria and/or nystagmus. Inquire about symptoms
Stage 2: Return to neutral, do 10 s count again
Stage 3: Repeat Stage 1 to other side
Stage 4: Repeat Stage 2 in neutral

Question 13

What is a common response to sustained cervical rotation?

Answer 13

Positional vertigo lasting 30-45 s

Question 14

What is a pathological response to sustained cervical rotation?

Answer 14

nystagmus and dizziness lasting minutes due to vascular disruption.

Question 15

When do you do the body-on-head test?

Answer 15

When sustained cervical rotation result is merely dizzy and not beyond that.

Question 16

How do you perform body-on-head test?
If test is positive, what do you suspect?
If test is negative, what do you suspect?

Answer 16

Same as sustained cervical rotation, but therapist holds head while pt rotates body to right and left.
+: vertebral artery
-: vestibular

Question 17

How many degrees of rotation does the patient have to get to during VAI testing to register a valid test?

Answer 17

45° because only this is enough to compromise vertebral artery.