Special Tests - Cervical Spine

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Author:
JLonghurst
ID:
19225
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Special Tests - Cervical Spine
Updated:
2010-05-13 17:48:28
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Special Tests Cervical Spine
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Special Tests Review of the Cervical Spine for the BOC
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  1. Compression Test (aka Spurling's Test)
    • Facet Joint Compression, Spinal Stenosis
    • Seat the patient and apply a downward force to the head with the neck in a neutral position. If this is negative the test can be performed in slight lateral flexion and/or extension with rotation. (Extension with rotation is often refered to as Spurling's Test.)
    • Pain in the upper c-spine and/or UE
  2. Nerve Root Compression Relief Test (Shoulder Abduction Test)
    • Confirmation of a suspected nerve root compression or disc injury
    • Patient sits and places arm of the affected limb on top of the head.
    • Reduction in patient’s symptoms is positive. If symptoms increase, they may be secondary to TOS.
  3. Cervical Distraction Relief Test
    • Nerve root compression injury
    • With the patient seated, place one hand on the base of the skull and the other under the chin. Gradually apply an upward traction force to the neck. Shoulder may be abducted to further reduce symptoms.
    • A reduction in symptoms is a positive sign.
  4. Shoulder Depression Test
    • Brachial Plexus Neuropathy
    • With the patient sitting, ask the patient to laterally flex the neck to the shoulder opposite the side manifesting the symptoms. Apply a downward force to the involved shoulder while applying lateral pressure to the head.
    • When the test is compared bilaterally the test will reproduce the symptoms on the affected side.
  5. Tinel's Sign
    • Brachial Plexus Neuropathy
    • Have the patient sit with neck slightly flexed. Tap over the nerve root next to transverse process.
    • Pain, tingling, parasthesia down brachial plexus distribution @ Erb's point
  6. Passive Upper Limb Tension Tests – Median Nerve Neuropathy
    • Median Nerve Neuropathy
    • With patient in supine position place the shoulder in slight abduction, lateral rotation, and full extension; the elbow in full extension; the wrist in extension and the fingers in extension. (Can also be performed with neck laterally flexed to opposite side.)
    • Reproduction or increase of symptoms
  7. Passive Upper Limb Tension Tests - Radial Nerve Neuropathy
    • Radial Nerve Neuropathy
    • With the patient in a supine position, place the shoulder in a slight abduction, medial rotation and extension; the elbow in full extension; the wrist in flexion and ulnar deviation; and the fingers in flexion.
    • Reproduction or increase of symptoms
  8. Passive Upper Limb Tension Tests - Ulnar Nerve Neuropathy
    • Ulnar Nerve Neuropathy
    • With the patient in supine, place the shoulder in abduction and lateral rotation; elbow in flexion; the wrist in extension and radial deviation; and the fingers in extension
    • Reproduction or increase of symptoms
  9. Active Upper Limb Tension Tests - Ulnar Nerve Neuropathy
    • Ulnar Nerve Neuropathy
    • Seat the patient and have them abduct the shoulder and place the hand of the involved side behind his head with the should in full lateral rotation. The elbow must be kept behind the body's mid line.
    • Reproduction or increase of symptoms
  10. Active Upper Limb Tension Tests - Median Nerve Neuropathy
    • Median Nerve Neuropathy
    • Seat the patient and have them abduct the shoulder to 90°. Fully extend the elbow. The fully laterally rotate the shoulder and move it posteriorly into horizontal abduction.
    • Reproduction or increase of symptoms
  11. Valsalva Maneuver
    • Disc Pathology
    • Patient takes a deep breath, holds it, and then bears down or blows into a closed fist.
    • Radiation of the symptoms down the compromised nerve root.
  12. Verterbral Artery Test
    • Compression of the vertebral artery
    • With the patient sitting or supine, passively most the patients neck into extension and larteral flexion, and then rotate it to the same side. Hold that position for 30 seconds.
    • Dizziness, confusion, unilateral pupil changes, nausea, nystagmus
  13. Adson's Test
    • Thoracic Outlet Syndrome
    • 1)Monitor the patient's radial pulse at the wrist while you abduct, extend, and externally rotate the upper extremity at the shoulder joint (keeping the elbow straight) 2)Have the patient take a deep breath, rotate, and extend their head TOWARD the side being tested
    • Marked decrease or absence of the radial pulse.
  14. Allen Test
    • Thoracic Outlet Syndrome
    • Locate the patients radial pulse and then position the upper extremity with the elbow at 90° flexion and the shoulder in lateral rotation and horizontal abduction. Have the patient rotate the head away from the tested arm.
    • Marked decrease or absence of the radial pulse.
  15. Military Brace Position (Costoclavicular syndrome test)
    • Thoracic Outlet Syndrome
    • Palpate the radial pulse with the patients shoulder and elbow in full extension. Position the shoulder in hyperextension and the head looking away from the side being tested.
    • Marked decrease or absence of the radial pulse.

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