Cervical and Thoracic Spine Tests Flashcards
Cervical Spinous Precussion
Pt. seated upright, palpate spinous processes of C3-C7. Have pt. bend forward and strike each process with reflex hammer.
Findings:
- Sharp pain: suggests fracture at that level.
- Zingy pain: suggests nerve root irritation.
- Dull, achy: suggests cancer metastasis.
Valsalva Maneuver
Pt. sitting upright. Ask pt. to bear down 3-5 seconds as though they are blowing up a balloon with their mouth blocked (they can put thumb in their mouth if it helps).
Findings:
Reproducing of symptoms is a good indication of disc lesions and bulges, or space occupying lesion.
(Increases intrathecal and intradiscal pressure which increases expansion of herniated nucleus pulposus and increases peripheral signs or symptoms).
Cervical Compression Test
Done with Spurling’s Test and Maximal Foraminal Compression Test.
Pt. is seated upright. Dr. stands behind pt and interlaces fingers and places two hands atop pt’s head. Stagger legs front and back. Slowly add axial pressure and push down until end feel or pt. pain. Release slowly.
Findings:
Pain, paresthesia, numbness is positive and indicates nerve compression or irritation or space occupying lesion.
(Arm symptoms suggest C6-C8 irritation).
Spurling’s Test
Pt. seated upright. Ask pt. to tilt head to one side without turning neck. Dr. clasps hands on top of head and again applies slow downward pressure. Release slowly.
Findings:
Pain, paresthesia, numbness is positive and indicates nerve compression or irritation or space occupying lesion.
(Arm symptoms suggest C6-C8 irritation).
Maximal Foraminal Compression
Pt. sitting upright. Ask pt. to look up over shoulder towards ceiling. Again clasp hands atop pt’s head and slowly apply downward pressure. Less pressure than the first two tests.
Findings:
Pain, paresthesia, numbness is positive and indicates nerve compression or irritation or space occupying lesion.
(Arm symptoms suggest C6-C8 irritation).
Cervical Distraction Test
Pt. seated upright. Place thumbs under patient’s occiput, thenar eminences under the mastoid processes. Lift the head from the shoulders by applying upward pressure at the mastoid processes.
Findings:
Decreased pain or arm sxs indicates nerve root irritation.
Increased pain indicates ligament or muscular sprain.
Shoulder Depression Test
Pt. seated upright. Ask pt. to tilt head to one side. Stabilize pt. head with one hand and with the other push down on shoulder gradually.
This stretches out the brachial plexus and nerve roots.
Findings: positive (pain, paresthesia, numbness) indicates irritation or compression of nerve root, spinal nerve or brachial plexus. Could also indicate adhesions or sprain on the side being stretched.
Soto Hall (Brudzinski)
Pt. lies supine, pt. puts one hand on sternum and dr. puts hand on top of pt’s hand on sternum (to prevent thoracic flexion). Put other hand behind head, and flex head towards the chest while maintaining pressure on sternum.
Findings: Reflex of flexing the knees is called the Brudzinski sign and indicates meningitis (or infxn or lesion). Localized pain indicates a vertebral fracture, joint or ligament injury, sprain.
Thoracic Spinous Percussion
Pt. seated upright. Palpate thoracic spinous processes (T1-T12). Have pt. tuck chin and roll shoulders forward. Percuss each spinous process with reflex hammer.
Findings:
Pain suggests fracture or metastasis. Disc lesions are NOT seen in the thoracic spine.
Forward Bending Test (Adam’s)
Scoliosis test. Observe pt’s back while standing, then have them bend forward, allowing arms to hang freely. If a “rib hump” is seen, this suggests structural scoliosis. If there is lateral curvature of the spine while standing straight but no “rib hump” is observed, this suggests functional scoliosis (muscular).
Adson’s Test
Stand behind pt. Find radial pulse of affected arm, externally rotate and extend the patient’s arm and shoulder (lift up a bit and pull back towards you). Ask pt. to rotate head in direction of extended arm.
Findings:
Loss of radial pulse is + and suggests vascular compression. Paresthesia or radiculopathy in the upper limb suggests neural compression.
Positive findings suggest thoracic outlet syndrome with involvement of the anterior scalene.
Reverse Adson’s Test
Stand behind pt. Find radial pulse of affected arm, externally rotate and extend the patient’s arm and shoulder (lift up a bit and pull back towards you). Ask pt. to look in opposite direction of extended arm. Can be done immedeatley following Adson’s.
Findings:
Loss of radial pulse is + and suggests vascular compression. Paresthesia or radiculopathy in the upper limb suggests neural compression.
Positive findings suggest thoracic outlet syndrome with involvement of the middle scalene.
Eden’s Test
Stand behind seated pt. Lift both arms and pull back while monitoring each radial pulse. Ask pt. to sit up in military posture: very straight, chest out, shoulders back, then take a deep breath and tuck their chin.
Findings:
Loss of pulse is + test and suggests vascular compression; more specifically, costoclavicular thoracic outlet syndrome
Roos Test
Ask pt. to abduct arms to 90 degrees with elbows flexed to 90 degrees. Brace elbows and open and close hands 2x a second for 3 minutes.
Findings:
Positive: inability to keep up pace, downward drift of arms, pain in hands, parasthesia. Suggests costoclavicular thoracic outlet syndrome.
Wright’s Test
Stand behind patient, holding their arms out to the side, palms facing anteriorly, monitoring radial pulse. Pt. relaxes arms and dr. slowly raises arms up. Observe for the angle of abduction at which pulse disappears.
Findings:
Positive test suggests compression of the neurovascular bundle by pectoralis minor muscle or an enlarged coracoid process.
Allen Test
Ask pt. to hold their arm above head. Occlude the radial and ulnar arteries with fingers. Have pt. squeeze their fist a few times to drain blood. Bring arm back down and release ONE of the arteries. Should perfuse in <5 seconds. Repeat with other artery.
Findings:
Used to rule out distal arterial disease or compromise in patients with hand symptoms (numbness, tingling).
Upper Limb Tension
(Median Nerve)
Pt. lies on back. First, depress pt’s shoulder and abduct glenohumeral joint to 90 degrees. Then externally rotate glenohumeral joint to 90 degrees (now making an “L”). Supinate the forearm, and extend the wrist and fingers, followed by the elbow. Have pt. laterally flex neck to contralateral side (see if it causes pain), followed by ipsilateral side (see if it relieves pain).
Findings:
Reproduction of the patients neck and arms symptoms or pain that travels along a dermatome or the course of a peripheral nerve is a +. Suggests nerve tension or impingement.
If flexing neck to ipsilateral side relieves sxs, this indicates cervical nerve root involvement. If it doesn’t relieve pain, the issue is further away.
