C-Spine - Special Test

Question 1

Vertebral Artery Test

Answer 1

purpose: Assess vertebrobasilar insufficiency

perform: Patient supine or seated. Passively extend, laterally flex, and rotate head to one side. Hold for 30 seconds.

positive: Dizziness, nystagmus, nausea, or visual changes = positive

Question 2

Hautant’s Test

Answer 2

purpose: Differentiate vascular vs vestibular cause of dizziness

perform: Patient seated with arms flexed to 90° and eyes closed. Head is rotated and extended. Hold position.

positive: Arm drift or loss of position = vascular impairment

Question 3

Transverse Ligament Stress Test

Answer 3

purpose: Integrity of transverse ligament stabilizing C1–C2

perform: Patient supine. Support occiput with fingers in C1 arch. Gently lift head anteriorly without flexion.

positive: Excessive movement, soft end-feel, or symptoms = positive

Question 4

Sharp-Purser Test

Answer 4

purpose: Assess atlantoaxial instability (transverse ligament) = determine subluxation of the atlas on the axis

perform: Patient seated. Examiner stabilizes C2 with hand and pushes posteriorly on forehead while patient is slightly flexed.

positive: Clunk or symptom relief = positive

Question 5

Anterior Shear Test

Answer 5

purpose: Integrity of upper cervical ligaments (alar, transverse)

perform: Patient supine. Examiner applies anterior glide to C1–C2 on a stabilized cranium.

positive: Nystagmus, nausea, soft end-feel, or paresthesia = positive

Question 6

Foraminal Compression (Spurling’s) Test

Answer 6

purpose: Cervical radiculopathy

perform: Patient seated. Examiner extends, rotates, and laterally flexes neck toward affected side, applies downward pressure.

positive: Radiating pain or paresthesia = positive

Question 7

Maximum Cervical Compression Test

Answer 7

purpose: Nerve root or facet joint compression

perform: Patient seated. Examiner passively extends and rotates head toward symptomatic side.

positive: Pain radiating into arm or local neck pain = positive

Question 8

Distraction Test

Answer 8

purpose: Cervical radiculopathy or facet joint relief

perform: Patient sitting and distract the head passively

positive: Symptom relief (arm or neck pain) = positive

Question 9

Shoulder Abduction Test

Answer 9

purpose: Cervical radiculopathy (C4–C6)

perform: Patient seated. Instruct to place hand on top of head.

positive: Reduction of radicular symptoms = positive

Question 10

Lhermitte’s Sign

Answer 10

purpose: Spinal cord or cervical myelopathy

perform: Patient seated or long-sitting. Examiner passively flexes neck forward.

positive: Electric shock-like sensation down spine or limbs = positive