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MSK1 > 7.4: Cervical Spine - Special Tests > Flashcards

7.4: Cervical Spine - Special Tests Flashcards

(75 cards)

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1
Q

PT places 1 hand under the chin and the other one the Occiput of the pt then slowly lifts the pt’s head

A

Distraction Test

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2
Q

Increased pain on distraction may be the result of

A

Muscle spasm, ligament sprain, muscle strain, dura irritability, or disc herniation

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3
Q

Compression test with 3 stages

A

Spurling’s Test

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4
Q

First stage of spurling

A

Compression of the head in neutral

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5
Q

Other name for spurling’s

A

Foraminal Compression Test

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6
Q

2nd stage of spurling

A

Compression with head in extension

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7
Q

Spurling’s Final stage

A

Compression with head in extension and rotation to the unaffected side

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8
Q

When to use spurling

A

when pt complains of radicular Sx

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9
Q

Provocative Tests for neurologic symptoms

A

Spurling’s

Jackson’s

Maximum Cervical Compression Test

Upper Limb Neurodynamic Test

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10
Q

Positive Sign for distraction test

A

pt’s Sx are relieved or decreased

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11
Q

positive sign for spurling’s

A

provocation of Sx

Symptoms radiates into the arm into which head is side flexed during compression

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12
Q

Spurling’s test may lead to Sx of what conditions?

A

Stenosis

Spondylosis

Osteophytes

Trophic, Arthritic, or Inflammed Facet Joints

Herniated Disc

Vertebral Fx

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13
Q

During spurling’s test, if pain or other symptoms is felt on the contralateral side of the head’s side bending direction, what is it called?

A

Reverse Spurling’s Sign

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14
Q

Reverse Spurling’s Sign is indicative of what?

A

Muscle Spasm in conditions such as:

Tension Myalgia

Whiplash Associated Disorders (WADs)

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15
Q

test where pt side flexes and rotates head to the same side

A

Maximum cervical compression test

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16
Q

In maximum cervical compression test, if the pain is felt on the concave side, it indicates what?

A

Nerve root or facet joint pathology

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17
Q

In maximum cervical compression test, if the pain is felt on the convex side, what does it indicate?

A

muscle strain

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18
Q

The position should be held for how long if using maximum cervical compression test for testing the artery

A

20-30 seconds

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19
Q

Modification of Spurling’s where pt rotates the head to one side then PT carefully presses straight down to the head

A

Jackson’s Compression Test

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20
Q

T/F: In the compression tests, dermatomal distribution of the Sx will not determine the nerve root involved

A

False

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21
Q

Test used for radicular symptoms, especially those involving the C4 or C5 nerve roots

A

Bakody’s/Shoulder Abduction (relief) test

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22
Q

Starting position of pt in Bakody’s

A

Sitting or Supine

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23
Q

How to do Bakody’s

A

PT passively or pt actively elevates the arm through abduction so that the hand/forearm rests on top of the head

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24
Q

Decrease of Sx in Bakody’s indicates what?

A

herniated disc

Epidural vein compression

Nerve root compression

All of which are usually in the C4-C5 or C5-C6 area

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25
Abduction of the arm decreases the ______ of the neurological pathway and ______ on the lower nerve roots
Length of the neurological pathway and pressure on the lower nerve roots
26
Increase in pain during bakody indicates what?
Increasing pressure in the interscalene triangle
27
Special Test equivalent to the straight leg test in the lumbar spine
Upper Limb Neurodynamic (Tension) Test
28
Contraindications for ULNT?
cauda equina or spinal cord lesions neurological signs are worsening or in the acute stage
29
Essential force to be applied on the shoulder during ULNT
Depression force
30
Why is depression force in ULNT essential?
so that even in abduction, the shoulder girdle remains depressed if the shoulder is not held in depression, the tests are not likely to work
31
Position of ULNT 1
Shoulder - Depression and abduction (110 deg) Elbow - extension forearm - supination wrist - extension fingers - extension cervical spine - contralateral side flexion
32
Position of ULNT 2
Shoulder - depression, abduction (10*), and ER Elbow - extension forearm - supination wrist - extension fingers - extension cervical spine - contralateral side flexion
33
Position of ULNT 3
Shoulder - depression, abduction (110*), and IR elbow - extension forearm - pronation wrist - flexion and ulnar deviation fingers - flexion cervical spine - contralateral side flexion
34
Position of ULNT 4
Shoulder - depression, abduction (10 to 90 deg), and ER Elbow - flexion Forearm - supination or pronation Wrist - extension and radial deviation Fingers - extension Cervical Spine - contralateral side flexion
35
What is tested in ULNT 4
Ulnar nerve, C8 and T1 nerve roots
36
What is tested in ULNT 3
Radial nerve
37
What is tested in ULNT 2
Median nerve, musculocutaneous nerve, axillary nerve
38
What is tested in ULNT 1
Median nerve, anterior interosseous nerve, and C5, C6, C7 nerve roots
39
Normal sensations in ULNT
Deep ache/stretch in the cubital fossa (99%) Deep ache/stretch into anterior and radial aspect of forearm and radial aspect of hand (80%) Tingling to the fingers supplied by the appropriate nerve (nerve bias) Stretch in the anterior shoulder Above responses increased with contralateral cervical side flexion and decreased with ipsilateral cervical side flexion
40
Positive indications for ULNT
Production of pt's Sx (most important) A sensitizing test in the ipsilateral quadrant alters the Sx Different Sx between right and left (contralateral quadrant)
41
Modification of the ULNT
brachial plexus tension test
42
procedure for brachial plexus tension test
Sitting pt abducts arms c elbow extended, stopping at the onset of Sx Then PT holds this position while pt flexes their elbows so that the hands lie behind their head
43
What is stressed in the brachial plexus tension test
Primarily the Ulnar nerve, and C8-T1 nerve roots (Similar to ULNT4)
44
Test used to determine the effect of increased pressure in the spinal cord
Valsalva Test
45
Maneuver for Valsalva Test
Pt is asked to take a deep breath while bearing down (as if moving the bowels)
46
Positive indication for valsalva test
increased pain that may be caused by increased intrathecal pressure
47
what are possible causes of a positive valsalva test
space-occupying lesions such as herniated discs, tumors, stenosis, or osteophyte formations
48
Why should the valsalva test be done with caution
Pt may become dizzy and pass out during or shortly afterward the test if the procedure blocks the brain's blood supply
49
What is romberg test used for
upper motor lesion
50
Procedure for romberg test
pt is in standing and is asked to close the eyes for 20-30 seconds
51
positive indication for romberg
pt's body sways excessively or pt loses balance
52
T/F: Vertebral Artery (Cervical Quadrant) Test and the special test for VBI have the same procedure
True
53
Procedure for Vertebral artery (cervical quadrant) test
pt is in supine while PT passively takes pt's head and neck into extension and side flexion PT then rotates the neck to the same side as the side flexion and holds position for approx. 30 sec
54
Positive indication for Vertebral artery (cervical quadrant) test
Provoking sx if the opposite artery is affected dizziness and nystagmus indicates compression of the vertebral artery
55
Tests for cervical instability
Sharp-Purser Transverse (lateral) shear test Lateral flexion alar ligament stress test Rotational alar ligament stress test Transverse ligament stress test
56
Procedure for lateral flexion alar ligament stress test
Pt lies in supine c head in the neutral position > PT stabilizes the axis c a pinch grip around the spinous process & lamina > PT attempts to side flex the head and axis
57
What is to be expected during lateral flexion alar ligament stress test for normal individuals
Minimal side flexion with a strong capsular endfeel and a solid stop
58
Procedure for Lateral (transverse) shear test
Pt lies in supine c head supported > PT places their 2nd MCP joint of one hand against the transverse process of the atlas and the 2nd MCP of the other hand over the opposite transverse process of the axis > PT's MCPs are then pushed together causing shear of one bone on the other
59
What is to be expected during the lateral shear test for normal individuals
Minimal motion and no Sx Pain is a normal sensation d/t the compression of the soft tissues against the bone
60
Why is lateral shear test used
to determine the instability of the atlantoaxial articulation caused by odontoid dysplasia
61
T/F: The lateral shear test can also be used to test the other cervical spine levels
True
62
Procedure for the rotational alar ligament stress test
Pt is in sitting > PT grips lamina and spinous process of C2 between their finger and thumb > PT then passively rotates the head left or right moving to the "no Sx" side first while stabilizing C2
63
Positive indication for Rotational Alar Ligament Stress Test
More than 20 to 30 degrees of rotation without C2 moving
64
What does a positive Rotational Alar Ligament Stress test indicate?
injury to the contralateral alar ligament especially if the lateral flexion stress test is positive in the same direction
65
What does excess motion in Rotational Alar Ligament and Lateral Flexion Alar Ligament Stress Test indicate
instability is due to an increase in the neutral zone in the joint
66
Why is Sharp-Purser Test done
to determine sublaxation of the atlas on the axis
67
What will happen if the transverse ligament that maintains the position of the Odontoid process on the C1 is torn
C1 will translate forward on C2 during flexion
68
procedure for Sharp-purser test
PT places one hand on pt's forehead while the thumb of the other hand over the spinous process of C2 (first palpable spinous process after occiput) > ask pt to slowly flex the head while PT presses the head backward with the palm
69
Positive indication for Sharp-Purser test
PT feels the pt's head sliding backward
70
What to do if PT feels the pt's head sliding backward during Sharp-Purses
IMMEDIATELY STOP
71
Tests for Thoracic Outlet Syndrome
Adson's Military Brace (Costoclavicular Syndrome) test Wright test
72
Procedure for Wright test
Pt's arm is hyperabducted so that the hand is brought over the head c elbow and arm in the coronal plane c shoulder in ER
73
Positive indications for the TOS special tests
Disappearing Radial Pulse
74
Procedure for Adson's
PT palpates for the radial pulse > pt's head rotates to the side that is tested > pt then extends the head & PT puts the shoulder into extension and ER > pt is asked to take a deep breath
75
Procedure for Military Brace/Costoclavicular Syndrome Test
PT palpates the radial pulse then draws the pt's shoulder down and back

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