PTRS 846: Special Tests Used for Red Flag Screenings

TLA Laxity Test

Pt is seated and the clinician standing to the side of the patient. The clinician grasps the cranium with one hand while stabilizing C2 against C3 in a ventral caudal direction. Then ,the clinician translates the cranium and C1 in a ventral direction. The test is repeated in each lateral direction by translating the cranium and C1 toward him/her

TLA Laxity Test Interpretation

Positive with reproduction of symptoms

Sharp Purser Test

Pt is seated and the clinician standing to the side of the patient. Theclinician grasps the cranium with one hand while locating the dorsal tip of the C2 spinous process with the other. Then the clinician gently distracts the head and neck while tipping the head forward around the upper cervical axis, so to separate the Dens from the anterior C1. Finally, the clinician attempts to translate the C2 segment forward.

Sharp Purser Test Interpretation

The test is positive for TLA instability when the clinician detects a "clunk" during the anterior translation of C2, reflecting a reduction of a subluxed Dens

Alar Ligament Testing

Pt is supine, stabilize C2 by placing hands in a "lumbrical" position and assess SB in neutral, flexion, and extension

Alar Ligament Testing Interpretation

Laxity in all three positions

Spurling Test

Pt is sitting EOB, therapist is behind pt; guide pt in ext

and SB to involved side, apply downward pressure

Spurling Test Interpretation

Radicular symptoms in ipsilateral arm

Scapulohumeral Reflex

Pt is seated and the clinician standing to the side of the patient. The clinician uses the reflex hammer to strike the superior tip of the lateral acromion process and/or the superior midpoint of the scapular spine.

Scapulohumeral Reflex Interpretation

The test is positive when the patient involuntarily shrugs the shoulder and/or abducts the glenohumeral joint in response to the reflex hammer strike

Femoral Nerve Tension Test

Pt is sidelying on the side opposite of the testing side. Bottom let hip and knees are flexed (ask pt to hold knee in flexion. The clinician is standing behind the pt. The clinician extends the hip with the knee extended, while stabilizing the pelvis. When the hip reaches full extension, the knee is then flexed. Finally the head and neck are extended.

Femoral Nerve Tension Test Interpretation

The test is positive when the knee extension increases the patient's symptoms and the head/neck extension changes the symptoms

SLR and Slump

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