cervical special tests Flashcards Preview

PHTH 7232 Ortho > cervical special tests > Flashcards

Flashcards in cervical special tests Deck (92):
1

Sharp-Purser test indications:

MVA or other cervical trauma (can assume + if pt has Down Syndrome or RA)

(Tests for Upper cervical instability; tests integrity of transverse ligament of the the dens)

2

Sharp-purser test interpretation.

Positive if a clunk is felt

or

there is a reduction in symptoms during test.

(It tests for Upper cervical instability; tests integrity of transverse ligament of the the dens)

3

Sharp-Purser Implications for positive test

Upper cervical instibility of C1 on C2

Tests integrity of transverse ligament of dens

4

Alar Ligament (occipital part) test Indications

MVA or other cervical trauma

Can assume it is positive if pt has Down Syndrome or RA

5

Alar Ligament (occipital part) Method 1 (of 2) technique:

Stabilize C2 and passively laterally flex.

(if ligament is intact (-), then will feel resistance to LF; If ligament unstable (+) then will have soft (or no) end-feel or excessive movement)

6

Alar Ligament (occipital part) Method 2 (of 2) technique:

Palpate C2 and have patient laterally flex

(If ligament intact (-), sp proc of C2 will move contralaterally; if ligament unstable (+) then C2 won't move)

7

Alar Ligament (occipital part) implications of positive test:

Unstable alar ligament (occipital portion) and resultant instability of the dens

8

What two Cervical special tests are indicated if a patient has MVA or other cervical trauma?

Sharp-Purser

Alar Ligament (occipital part)

9

Vertebral Artery Test Indications

All patients (especially if planning to do end ROM treatments with them). And especially if they have any of the 5 D's (Dizziness, diplopia, dysphagia, dysarthria, & drop attacks).

10

5 D's

  1. Dizziness
  2. diplopia
  3. dysphagia
  4. dysarthria
  5. drop attacks

11

Diplopia

double vision or blurred vision

12

dysphagia

problems with swallowing

13

dysarthria

difficulty speaking

14

drop attacks

More than one definition it seems but I liked this one: "Drop attacks are sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes. There is usually no recognized loss of consciousness and the event is remembered."

15

Vertebral Artery Test: how to perform

Pt position: supine

Passively fully extend and LF while watching eyes, hold 30s ; if (-) then add rotation towards LF and hold 30 more seconds. The side being tested is the side contralateral to the LF.

16

Vertebral Artery test: what is a positive test? (includes 5 symptoms)

Positive if following symptoms occur during test:

  1. dizziness
  2. nausea
  3. vertigo
  4. visual changes
  5. nystagmus

17

Sharp-Purser Test: how to perform (quick summary)

Pt position: sitting

Patient slowly flexes neck while exainor provides posterior pressure with hand on forehead and anterior pressure on spinous process of C2. Attempting to apply sheer force to C1-C2.

18

What special tests could you perform to test disks and Nerve roots? (5)

  1. Compression test
  2. Distraction Test
  3. Spurling Test
  4. Repeated Protrusion test
  5. Repeated Retraction test

19

What special tests did we learn that are McKenzie based? (2)

1. Repeated Protrusion

2. Repeated Retraction

20

nystagmus

involuntary rapid eye movements

21

What special tests might you consider performing on a patient presenting with radicular symptoms? (9)

  1. Compression test
  2. Distraction test
  3. Spurling
  4. Repeated Protrusion test
  5. Repeated Retraction test
  6. ULTT1
  7. ULTT2
  8. ULTT3
  9. ULTT4

22

Indications for Compression test:

Radicular symptoms

23

Indications for Distraction test

Radicular symptoms (must be at rest for test to be performed)

24

Indications for Repeated Protrusion test:

Radicular symptoms

25

Indications for Repeated Retraction:

Radicular symptoms

26

Indications for ULTT1 test:

Radicular symptoms 

27

Indications for ULTT2 test:

Radicular symptoms

28

Indications for ULTT3:

Radicular symptoms

29

Indications for ULTT4 test:

Radicular symptoms

30

Compression test; how to perform:

pt position: sitting

Axial compression in neutral position (facing pt preferable)

31

Distraction test, how to perform:

Pt position: Sitting or Supine

Axial distraction in neutral position

32

Distraction test in sitting, advantages

sitting is a functional position so it may apply better to daily life

33

Distraction test in supine, advantages

can get more leverage; easier to apply more force

34

Spurling test method one, how to perform:

Pt position: sitting

Axial compression with LF toward side of symptoms

35

Spurling test method 2, how to perform:

pt position: sitting Stepwise:

  1. Axial compression in neutral (same as compression test)
  2. Axial compression during extension
  3. Axial compression during extension and rotation toward affected side

36

Repeated Protrusion test, execution:

pt position: sitting

protrude head and return to neutral 10 times. Stop when positive even before 10 times

37

Repeated Retraction test, how to perform

pt position: sitting

Retract head and return to neutral 10 times. Stop when positive even if before 10 times

38

Compression test: what is positive?

Positive if reproduction or peripheralization of symptoms occurs during test.

39

Distraction test: what is positive?

Positive if symptoms are decreased or centralized

40

What makes a positive Spurling test?

Positive at any step if distal symptoms are reproduced or peripheralized (either method).

If doing stepwize method, stop test after first positive result

41

What makes a positive Repeated Protrusion test?

Positive if distal symptoms are reproduced or peripheralized

42

What makes a positive Repeated Retraction test?

Positive if distal symptoms are decreased or centralized

43

What are implications of positive Compression test?

Compressed or irritated cervical nerve roots

44

What are the implications of a positive Distraction test?

Compressed or irritated cervical nerve roots

45

What is the implications of a positive Spurling test?

Compressed or irritated cervical nerve roots

46

What is the implications of a positive Repeated Protrusion test?

Compressed or irritated cervical nerve roots with mechanical cause (derangement)

47

What are the implications for a positive Repeated Retraction test?

Compressed or irritated cervical nerve roots with mechanical cause (derangement)

48

What is the test procedure for the ULTT1 test?

  1. shoulder depression
  2. shoulder abduction 110 degrees
  3. shoulder ext. rotation
  4. forearm supination
  5. wrist extension
  6. finger/thumb extension
  7. elbow extension
  8. contralateral cervical side bending

49

What is the test procedure for the ULTT2 test?

  1. shoulder depression
  2. shoulder abduction 10 degrees
  3. shoulder ext. rotation
  4. forearm supination
  5. wrist extension
  6. finger/thumb extension
  7. elbow extension
  8. contralateral cervical side bending

50

What is the test procedure for the ULTT3 test?

  1. shoulder depression
  2. shoulder abduction 10 degrees
  3. shoulder int. rotation
  4. forearm pronation
  5. wrist flexion and Ulnar Deviation (UD)
  6. finger/thumb flexion
  7. elbow extension
  8. contralateral cervical side bending

51

What is the test procedure for the ULTT4 test?

  1. shoulder depression
  2. shoulder abduction 90 degrees
  3. shoulder ext. rotation
  4. forearm pronation
  5. wrist extension & radial deviation (RD)
  6. finger/thumb extension
  7. elbow flexion
  8. contralateral cervical side bending

52

What shows a positive ULTT1 test?

Reproduction of patient's symptom

and/or

different symptoms between involved and uninvolved

53

What shows a positive ULTT2 test?

Reproduction of patient's symptom

and/or

different symptoms between involved and uninvolved

54

What shows a positive ULTT3 test?

Reproduction of patient's symptom

and/or

different symptoms between involved and uninvolved

55

What shows a positive ULTT4 test?

Reproduction of patient's symptom

and/or

different symptoms between involved and uninvolved

56

What is implicated when ULTT1 is positive? (3)

  1. Median nerve
  2. Anterior interosseus nerve
  3. C5, C6, C7

57

What is implicated when ULTT2 is positive? (3)

  1. Median nerve
  2. Musculocutaneus nerve
  3. axillary nerve

58

What is implicated when ULTT3 is positive? (1)

Radial nerve

59

What is implicated when ULTT4 is positive? (2-3)

Ulnar nerve

C8 & T1 nerve roots

60

Normal responses (negative results) to ULTTs: (4)

  1. Deep ache/stretch in cubital fossa
  2. deep ache/stretch onto anterior or radial aspect of forearms and radial aspect of hand
  3. Tingling in the fingers supplied by appropriate nerve
  4. Stretch to anterior shoulder area

61

Abnormal responses (positive results) to ULTTs: (2)

  1. Production of patient's symptoms (that they came in for) - most important
  2. Different symptoms between involved and uninvolved side

62

Four Thoracic outlet syndrome tests

  1. Adson Maneuver
  2. Wrights Maneuver/Hyper- Abduction
  3. Capillary Refill
  4. Roos Test

63

Symptoms of  Thoracic Outlet Syndrome (same as indications for tests)? (4)

  1. vague UE paresthesia
  2. achiness
  3. heaviness
  4. UE neuro deficits

64

Adson Maneuver, how to perform:

pt position: sitting

Palpate radial pulse; pt performs shoulder extension and ER; pt fully extends head and rotates it ipsilaterally; patient holds deep breath 4 seconds.

65

Wright's maneuver/hyper-abduction test, how to perform:

pt position: sitting

Palpate radial pulse. Hyper-abduct arm with elbow extended and hold for 4 seconds.

66

Capillary Refill test, how to perform

Blanch nail bed and release. Should re-fill within 3 seconds

67

Roos test, how to perform

pt position: sitting

In 90/90 position, pt clenches/unclenches fist repeatedly for 3 minutes. elbows must not drop

68

Adson maneuver, positive result

Decreased radial pulse or reproduction of symptoms

(50% normal patients experience decrease radial pulse)

69

Wright's maneuver/Hyper-abduction test, positive result

Decreased radial pulse or reproduction of symptoms

(50% normal patients experience decrease radial pulse)

70

Capillary refill test, positive test

Refill takes longer than 3 seconds to return to normal color

71

Roos test, positive results

Reproduction of symptoms or inability to maintain test position secondary to heaviness/profoudn weakness of the arm.

(many healthy individuals have trouble with this test, or pt may stop due to forearm fatigue and discomfort)

72

What is implicated when Adison maneuver is positive?

Roots of brachial plexus, especially C8-T1

73

What is implicated when Wright's maneuver/hyper-abduction test is positive?

Roots of brachial plexus, primarily C8-T1

74

What is implicated when Roos test is positive?

Roots of brachial plexus, primarily C8-T1

75

What is implicated when Capillary Refill test is positive?

Vascular impairment (possibly due to TOS)

 

TOS = Thoracic Outlet Syndrome

76

TOS is

Thoracic Outlet Syndrome

77

What are the two cervical stabilization tests?

Cranial Cervical Flexion Test (CCFT) - one that uses BP cuff

Deep Neck Flexor Endurance Test (chin in max tucked position and neck lifted one inch)

78

CCFT

Cranial Cervical Flexion Test

79

CCFT (cranial cervical flexion test), how to perform

Hooklying with neck lying on BP cuff inflated to 20mmHg. Perform chin nod and assess (stage 1) quality of movement at each 2mm up to 30mmHg, then (stage 2) endurance holding 10s three times at each 2mm level from 20mmHg up to 30mmHg. Stop test if must stop at any part of any stage.

80

Response to CCFT (Cranial Cervical Flexion Test)

Stage One: assess quality of movment and compressions at each 2mm (20-30mmHG).

Stage Two (performed if able to do stage one): assess for ability to sustain 3 reps of 10 second hold at each 2 mm increment.

81

Implications of a CCFT (cranial Cervical Flexion Test)  - what does it assess or tell us?

Assess the facilitation and endurance of deep neck flexors and need for stabilization training

82

Indications for performing CCFT?

Chronic neck pain without s/s of nerve involvement.

Negative repeated motion tests

83

Indications for performing Deep Neck Flexor Endurance Test

Chronic neck pain without s/s of nerve involvement.

Negative repeated motion tests

84

How to perform Deep Neck Flexor Endurance test

Hooklying position with chin in max tucked position and neck lifted one inch from resting position. try to perform with minimal to no engagement of SCM

85

Deep Neck Flexor Endurance Test response (what does it assess and norms)

Assess ability to maintain position

Norm female: 29 seconds

Norm male: 39 seconds

86

Implications of Deep Neck Flexor Endurance Test

Assess the endurance of deep neck flexors and need for stabilization training

87

An upper cervical mobility test

Cervical Flexion-Rotation test

88

Indications for performing the Cervical Flexion-Rotation Test

Unilateral headache with onset preceded by neck pain. Headache triggered by neck motion.

89

How to perform the Cervical Flexion-Rotation Test

Patient position: supine

Examiner passively maximally flees cervical spine and then rotates to each side while assessing asymmetry in motion

90

What is a positive test for Cervical Flexion-rotation test?

> 10 degree asymmetry between sides is a positive test

91

Implications for a positive Cervical Flexion-rotation test

C1-C2 hypomobility and may lead to need for mobilization and/or suboccipital release

92

What spinal levels is the Cervical flexion-rotation test for

C1, C2, C3 (I think from my notes)