Special Tests

Hoffman’s Reflex

Tests For: UMN Lesion

Performance: Hold the patients hand by supporting their 3rd-5th digits and allow the 1st and 2nd digits to remain relaxed. Flick the patients nail of their middle finger three times

Positive Test: 1st and 2nd digits come together to make the “OK” sign

Tromner’s Reflex

Tests For: UMN Lesion

Performance: Hold the patients hand by supporting their 3rd-5th digits and allow the 1st and 2nd digits to remain relaxed. Flick the patients distal palmar tip of their middle finger 3 times

Positive Test: 1st and 2nd digits come together to make the “OK” sign

Inverted Supinator Sign

Tests For: UMN Lesion

Performance: PT performs a series of quick strikes on the brachioradialis tendon

Positive Test: patient demonstrates finger flexion or elbow extension

Babinski

Tests For: UMN Lesion

Performance: stroke the palmar surface of the patients foot in a curved pattern with the tip of the reflex hammer

Positive Test: patients toes extend and abduct instead of a flexion response

Clonus

Tests For: UMN Lesion

Performance: with the patient in seated or supine, passively rapidly dorsiflex the patients ankle

Positive Test: the patient reflexively plantar flexes into your hand at least four beats

Deep Neck Flexor Endurance Test

Tests For: Longus Colli Endurance

Performance: patient lies supine, performs retraction and slight cervical flexion

Positive Test: <24 seconds is considered to be impaired

Sharp Purser Test

Tests For: upper cervical instability caused by transverse ligament insufficiency

Goal: relocate C1 on C2 to diminish spinal cord compression

Performance: with the spine slightly flexed, the examiner stabilizes the C2 spinous process with a pinch grip. the examiner then pushes on the patients forehead in a posterior direction

Positive Test: reduction of radiating symptoms

Alar Ligament Test

Tests For: upper cervical instability caused by alar ligament insufficiency

Goal: assess the integrity of the alar ligament which resists rotation and side bending of the upper cervical spine

Performance: the examiner stabilizes the C2 spinous process with a pinch grip. the examiner passively moves the head into side bending bilaterally and rotation.

Positive Test: excessive motion, or C2 does not move when the examiner passively moves the head

Transverse Ligament Test

Tests For: upper cervical instability caused by transverse ligament insufficiency

Performance: examiner supports the posterior skull in their hands, passively lifts the head anteriorly while facilitating upper cervical extension and lower cervical flexion

Positive Test: a reproduction of radiating symptoms, symptoms of a lump in the throat

Lhermitte’s Sign

Tests For: compression of the cervical spinal cord due to myelopathy or upper cervical instability

Performance: patient performs active cervical flexion

Positive Test: patient reports a lighting bolt or electric shock sensation down their spine during the motion

Spurling’s Test

Tests For: cervical radicular pain

Performance: examiner passively sidebends and provides an axial load through the top of the patients head

Positive Test: a reproduction of patients symptoms, pain, numbness, and/or tingling down the upper extremity on the side that the head was sidebent towards

Distraction Test

Tests For: cervical radicular pain

Performance: examiner grasps the patients head around the patients mastoid processes and lifts cranially providing a distraction force

Positive Test: reduction of radicular symptoms

Bakody’s Sign

Tests For: cervical radicular pain

Performance: instruct the patient to rest their forearm on top of their head and assess symptom response

Positive Test: reduction of radicular symptoms

Median Nerve ULNT

Tests For: cervical radicular pain or median nerve peripheral nerve entrapment by providing a stretch to the median nerve and roots

Performance: examiner passively places the arm into the following positions sequentially: shoulder depression, shoulder abduction to 90 degrees and maximally externally rotated, the forearm is supinated, and the wrist and fingers are extended - the elbow is slowly extended until the patient notes symptoms

Positive Test: reproduction of patients radicular symptoms - may relieve with ipsilateral cervical side bend

Ulnar Nerve ULNT

Tests For: cervical radicular pain or ulnar nerve peripheral nerve entrapment by providing a stretch to the ulnar nerve and roots

Performance: examiner passively places the arm into the following positions: scapular depression, shoulder abduction to 90 degrees and maximally externally rotated, forearm is pronated, the wrist and fingers are extended, the elbow is slowly flexed until the patient notes symptoms

Positive Test: reproduction of patients radicular symptoms - may relieve with ipsilateral cervical side bend

Radial Nerve ULNT

Tests For: cervical radicular pain or radial nerve peripheral nerve entrapment by providing a stretch to the radial nerve and roots

Performance: examiner passively places the arm into the following positions: scapular depression, shoulder internal rotation, elbow pronation, and wrist/finger flexion around thumb, the shoulder is slowly abducted until the patient notes any symptoms

Positive Test: reproduction of patients radicular symptoms - may relieve with ipsilateral cervical side bend

Cervical Flexion-Rotation Test (CFRT)

Tests For: somatic referred pain or cervicogenic headaches from upper cervical spine by attempting to isolate the atlanto-axial joints

Performance: examiner maximally flexes the patients neck then passively rotates the neck to each side, noting the range of motion available and any symptoms

Positive Test: reproduction of patients chief complaint of neck pain or headaches, and/or a reduced ROM on one side compared to the other