Procedure for Rust’s Sign
If the patient spontaneously grasps the head with both hands when laying down or when rising from a recumbent position, then this is a positive sign.
A positive Rust’s Sign indicates what possible issues?
severe sprain, rheumatoid arthritis, fracture, severe cervical subluxation
Reporting statement for Rust’s Sign
Rust’s sign is present; this result suggests severe upper cervical (atlanto-axial) instability
Clinical indication for Rust’s Sign
Suggests, ligament, muscle damage or possible fracture. Note: X-ray patient before preforming any other tests
Procedure for Libman’s Sign
The examiner applies thumb pressure to the mastoid process and gradually increases the pressure until the patient states that it is becoming noticeably uncomfortable.
Reporting statement for Libman’s Sign
Libman’s sign demonstrates an unusually low, high, or normal threshold for pain in the patient.
Clinical indication for Libman’s Sign
Is useful for interpretation of palpation findings in later exams
Procedure for Bakody Sign
The patient will be in a seated position and will place the hand of the affected extremity on the top of their head, raising the elbow to the level of the ear.
Purpose/function of Bakody Sign
This is a position that the patient will assume if they have severe radicular symptoms. This decreases the traction of the lower part of the brachial plexus, and thus pain diminishes. This is a positive Bakody sign/test.
Findings for Bakody Sign
This is a sign that the patient has symptoms of a nerve root irritation. This is as effective as the compression tests and causes the patient a lot less pain. Note location of pain-it will help to identify the etiology
Findings for Reverse Bakody Sign
The pain of the patient’s chief complaint is exacerbated. This indicates a thoracic outlet syndrome from interscalene compression. This is a positive Reverse Bakody sign/test
Findings for Negative Bakody Sign
The patient experiences no change in the pain or there is no pain complaint in the neck and/or arm. This is a negative Bakody sign/test. Clinical indication: Differentiate a nerve root (IVF) encroachment from a thoracic outlet syndrome (TOS)
Procedure for Bikele’s Sign
The patient is asked to abduct the shoulder to 90 degrees, and then the elbow is put into full extension
Purpose/function of Bikele’s Sign
The patient is being placed in a position that will traction the brachial plexus and its nerve roots. Function: stressing the brachial plexus
Findings for Bikele’s Sign
The pain is radicular in nature and goes into the arm. Note the location of the pain; it will help to identify the etiology
Procedure for Brachial Plexus Tension Test
The patient is asked to abduct both shoulders to 90 degrees and place the hands behind the head. The doctor then pulls the elbows back.
Purpose/function of Brachial Plexus Tension Test
The patient is being placed in a position that tractions the brachial plexus and its nerve roots. Function: Stressing the brachial plexus
Findings for the Brachial Plexus Tension Test
The pain is radicular in nature and goes into the arm. Note the location of the pain-it helps identify etiology
Procedure for Dejerine’s Sign (aka Dejerine’s Triad, Triad of Dejerine)
Coughing, sneezing and straining during defecation may cause aggravation of radiculitis symptoms. This aggravation is due to the mechanical obstruction (space occupying lesion) such as a herniated or protruding intervertebral disc, spinal cord tumor, or spinal compression fracture.
Reporting statement for Dejerine’s Sign
Dejerine’s sign is present and suggests a space occupying mass at the C(?) level. The course of radiculitis helps identify the location of the lesion.
Cause of Dejerine’s Sign.
herniated or protuding intervertebral disc
spinal cord tumor
spinal compression fracture
Clinical indications of Dejerine’s Sign
Any sudden increase in intra-thoracic and intra-abdominal pressure blocks the venous flow from the epidural space through the intervertebral veins or a retrograde flow of blood because these veins do not comtain valves. The pressure increase causes a distention of the veins in the epidural space, which in turn forces the dura towards the spinal cord causing stretching of the nerve roots, which may result in pain. note location of pain
Procedure for Valsalva’s Maneuver
The doctor stands in front of the seated patient and the patient is asked to take in a breath and bear down as if they were laboring during a strenuous defecation. Patients may become dizzy due to a decreased cerebral blood supply.
Purpose/function of Valsalva’s Maneuver
To test for the presence of a space occupying lesion within the spinal column that is communicating with the spinal cord meninges; (eg. spinal cord tumor, IVD lesion, hemangiomas). Function: the patient is placing exhalation force against a closed glottis. This increases intra-thecal presure within the spinal cord.
Findings for Valsalva’s Maneuver
A sharp accentuation of pain at the level of the lesion usually indicates a space occupying lesion (eg. herniated disc, tumor, or osteophyte). Note the location of pain
Procedure for the Swallowing Test
While seated, the patient is instructed to swallow
Presence of pain or difficulty swallowing during the Swallowing Test indicates:
space occupying lesion ligamentous sprain muscular strain fracture disc protrusion tumor osteophyte at the anterior portion of the cervical spine
Reporting statement for the Swallowing Test
This result suggests esophageal irritation due to direct trauma or a retro esophageal space occupying lesion
Procedure for Naffziger’s Test
The doctor stands behind a seated patient and occludes the external jugular veins at the level of the clavicles for 10-15 seconds. The doctor then asks the patient to couch
Purpose/function of Naffziger’s Test
To create a pooling of the venous sinuses that will cause an increase in cerebral spinal fluid pressure (intra-thecal). Function: The backing up of venous flow along with the cough accentuates the intra-thecal pressure
Findings for the Naffziger’s Test
A sharp accentuation of the pain at the level of the lesion. Note the location of pain
Procedure for Barr’e-Lie’ou Test
While the patient is in a seated position, the doctor instructs the patient to rotate the head back and forth as fast as they can. If at any time the patient experiences symptoms the test is considered positive.
Purpose of Barr’e-Lie’ou Test
To rule out vascular insufficiency, cervicogenic vertigo, and possible vestibular apparatus abnormality
Reporting statement for Barr’e-Lie’ou Test
The test is considered positive if the maneuver reveals symptoms. Verigo, dizziness, visual disturbances, nausea, syncope, and nystagmus are all signs of a positive test
Clinical indications of Barr’e-Lie’ou Test
Vertigo, dizziness, visual blurring, nausea, faintness, and nystagmus are all sings of a positive test, which indicates vascular insufficiency, cervicogenic vertigo, and possible vestibular apparatus abnormality
Procedure for Vertebrobasilar Artery Functional Maneuver
While the patient is in a seated position, the doctor auscultates (using the bell) the carotid and subclavian arteries bilaterally. The doctor then palpates the carotid and subclavian arteries bilaterally. If no asymmetrical or diminished pulsations are felt or no bruits exist, the doctor instructs the patient to rotate and hyper-extend the head to one side. During full rotation and extension the patient should count backwards from 20 by 1’s. The patient should then repeat on the other side. Rotating the head causes compression of the vertebral arteries. If at any time the patient experiences symptoms the test is positive.
Purpose of Vertebrobasilar Artery Functional Maneuver
To rule out vascular insufficiency
Reporting statement for Vertebrobasilar Artery Functional Maneuver
The test is considered positive if either maneuver reveals bruits. A positive finding indicates a buckling of the ipsilateral vertebral artery. Vertigo, dizziness, visual disturbances, nausea, syncope, and nystagmus are all signs of a positive test. If positive sign is present on the right, this finding suggests vertebrobasilar insufficiency on the right.
What should be done if the patient has symptoms with the Vertebrobasilar Artery Functional Maneuver
MR Angio of the neck
MR Angio of the head
MRI of the head
Procedure for DeKleyn’s Test
While the patient is lying supine, the doctor instucts the patient to rotate and hyper-extend the head to one side. During full rotation and extension the patient should count backwards from 20 by 1’s. Rotating the head causes compression of the vertebral arteries. If the patient experiences symptoms the test is considered positive.
Purpose of DeKleyn’s Test
To rule out vascular insufficiency. Takes the horizon from vision so it may bring out symptoms that are subtle
Clinical indications for DeKleyn’s Test
Indicates vertebral, basilar, or carotid artery stenosis or compression.
Procedure for the Distraction Test
With the patient seated, the doctor exerts upward pressure on the patients head. This removes the weight of the patient’s head from the neck. Generalized, increased pain indicates muscle spasm. Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis. The doctor holds the distraction for 30-60 sec.
Purpose of the Distraction Test
Confirm IVF encroachment
Reporting statement for the Distraction test
Distraction test is positive in relieving the C(?) radicular pain on the right. This result suggests nerve root compression syndrome at that level, on the right.
Clinical indications of the Distraction test.
Increased pain indicates muscle spasm. Relief of pain indicates intervertebral foraminal encroachment or facet capsulitis.
Procedure for Foraminal Compression Test
With the patient in the seated position the patient actively rotates the head from side to side. Note pain and the location of the pain if present. The doctor then exerts strong downward pressure with the head in the neutral position, noting any radicular pain. The doctor then rotates the patient’s neck while exerting strong downward pressure on the head.
Purpose of Foraminal Compression Test
To confirm IVF encroachment and nerve root involvement
Reporting statement for Foraminal Compression Test
Foraminal compression testing is positive on the right, in the C(?) dermatome
Clinical indications for Foraminal Compression Test
When the neck is rotated and downward pressure is applied, closure of the intervertebral foramen occurs. Localized pain indicates foraminal encroachment. Radicular pain indicates pressure on the nerve root. If nerve root involvement is suspected, the neurological level must be evaluated. Note the location of pain
Procedure for Jackson Compression Test
With the patient in the seated position the patient actively rotates the head from side to side. Note pain. The patient then actively laterally flexes the head from side to side. Note pain. The doctor then exerts strong downward pressure with the head in the neutral position. Note pain. The doctor then laterally flexes the patient’s neck while exerting strong downward pressure on the head. Note pain. Pressure should be maintained for 30-60 sec
Purpose of Jackson Compression Test
To confirm IVF encroachment and nerve root involvement
Reporting statement for Jackson Compression Test
Jackson cervical compression is positive on the right and elicits pain in the C(?) dermatome
Clinical indication of Jackson Compression Test
Pain on the side opposite of rotation suggests muscular strain, while pain on the side of rotation suggests facet or nerve root involvement. Local or radicular pain indicates a positive test. Note the location of pain
Procedure for Maximum Cervical Compression Test
While in the seated position, the patient is instructed to approximate the chin to the shoulder (fully rotating the head), laterally flex and then extend the neck. The test is performed bilaterally. Pain on the concave side indicates nerve root or facet involvement. Pain on the convex side indicates muscular strain. Note the location of pain
Purpose of Maximum Cervical Compression Test
To confirm IVF encroachment and nerve root involvement
Reporting Statement for Maximum Cervical Compression Test
Maximum cervical compression on the right is positive on the right. This result suggests neural compression at C(?)
Clinical indications for Maximum Cervical Compression Test
Pain of a radiating nature on the side being tested is indicative of IVF encroachment. Pain local to the side being tested is indicative of facet capsulitis. Pain opposite the side being tested is indicative of muscle stretch or strain. Note the location of pain
Procedure for Spurling’s Test
With the patient in the seated position, the patient actively rotates the head from side to side. Note pain if any. If no pain continue. The patient actively laterally flexes the head from side to side. Note pain if any. If no pain continue. The doctor then exerts strong downward pressure with the head in the neutral position. Note pain if any. If no pain continue. The doctor then laterally flexes and extend the patient’s neck as far as tolerated, while exerting strong downward pressure on the head. Note pain if any. If no pain continue. Then, with the patient in the seated position and with the head in the neutral position, the doctor delivers a vertical blow to the uppermost portion of the cranium
Purpose of Spurling’s Test
To confirm IVF encroachment and nerve root involvement
Reporting statement for Spurling’s Test
Spurling’s test is positive on the right with pain and paresthesia elicited in the C(?) dermatome. Note any pain or paresthesia and the distribution thereof.
Clinical indications for Spurling’s Test
This maneuver closes the intervertebral foramen on the side of the flexion and reproduces the familiar pain or paresthesia. Note the location of the pain
Procedure for Lhermitte’s Test
With the patient seated the doctor instructs him/her to drop their chin to their chest. The doctor then passively flexes the patients head.
Purpose/Function of Lhermitte’s Test
To traction the posterior column of the spinal cord. Function: this maneuver causes a sudden tractioning of the spinal cord
Findings for Lhermitte’s Test
An electric shock like sensation radiating down the neck and spine is a sign of posterior column disease of the spinal cord and also is a classic sign of Multiple Sclerosis. Note the location of pain
What should be done if there is a positive Lhermitte’s Test
If positive, do MRI. If symptoms occur in lower extremities, do a thoracic MR including end of the cord. If both hands and feet have symptoms, do a cervical MR.
Procedure for O’Donoghue Maneuver
While the patient is sitting, the cervical spine is actively moved through range of motion, then through passive range of motion, then through resisted range of motion. This test can be done on any joint of the body
Purpose of O’Donoghue Maneuver
To stress the musculature involved in the motion of the joint being tested
Reporting statement for O’Donoghue Maneuver
O’Donoghue maneuver is positive for strain of the cervical spine. O’Donoghue is positive for muscular strain of the cervical spine
Clinical indication for O’Donoghue Maneuver
Pain during resisted rand of motion or isometric contraction signifies muscle strain. Pain during passive range of motion signifies ligamentous sprain.
Procedure for Kernig Sign
For the Kernig part of the sign, the patient is supine. The doctor flexes the hip and knee of either leg to 90 degrees, respectively. The doctor attempts to completely extend the leg. If pain prevents this, headache will increase, the sign is present. The sign is often accompanied by involuntary flexion of the opposite knee and hip and is present in meningitis. positive sign is headache increases
Reporting Statement for Kernig Sign
The Kernig/Brudinski sign is present. This indicates meningeal irritation or inflammation
Clinical indications of Kernig Sign
Possible meningeal irritation
Procedure for Brudzinski Sign
For the Brudzinski part of the sign, the patient is in the supine position, and the doctor passively flexes the patient’s head. The sign is present if flexion of both knees occurs. Headache will increase. The sign is frequently accompanied by flexion of both hips and is present with meningitis. positive if headache increases?
Reporting statement for Brudzinski Sign
The Kernig/Brudzinski sign is present. This sign indicates meningeal irritation or inflammation
Clinical indications of Brudzinski Sign
Possible meningeal irritation
Procedure for Shoulder Depression Test
The patient is seated and the doctor stands behind and lateral to the mid-line of the side being tested. The doctor laterally flexes the head away from the side being tested. While stabilizing the head, an inferior force is placed on the ipsilateral shoulder.
Purpose/Function of Shoulder Depression Test
To traction the brachial plexus and its nerve roots between the cervical spine and the shoulder complex. Function: this test tractions the brachial plexus and it’s associated nerve roots
Findings for Shoulder Depression Test
Radicular symptoms may be caused by:
Fibrosis in the IVF
Adhesions to the dural sleeve
Tractioning the nerve root across osteophytes
Edema or compression of the nerve root at the IVF
Radiating symptoms may also be caused by: tractioning the nerves across a cervical rib, soft tissue involvement
Procedure for Soto-Hall Test
The patient is placed supine. The doctor places one hand on the sternum of the patient and exerts slight pressure so that no flexion can take place at either the lumbar or thoracic regions of the spine. The doctor places the other hand under the patient’s occiput and passively flexes the head toward the chest. (similar to Brudzinski but patient doesn’t have a fever)
Purpose/Function of Soto-Hall Test
The test is primarily employed when fracture of a vertebra is suspected. This test is also used to produce a progressive traction on the spinous tissues and cause compression of the vertebral bodies. Function: this procedure produces a progressive pull on the posterior spinous ligaments starting at the Ligamentum Nuchae above and being transmitted downward to the interspinous ligaments until it reaches the spinous process of the involved vertebra where it acts as a lever compressing the body and producing pain. (Does NOT mean a fracture if positive- look at history)
Findings for Soto-Hall test.
localized dull or sharp pain in the cervical spine that may radiate to the thoracic spine may be caused by:
Sprain/Strain
Avulsion Fracture
Facet Involvement
A sharp accentuation of pain with radiculopathy suggests a possible space occupying lesion
(Note location of pain)
