Cervical Special Tests and Manual Techniques

Spurling’s test

is a clinical examination maneuver used to diagnose cervical radiculopathy. It involves neck extension and lateral rotation towards the affected side while applying downward pressure, which may reproduce pain or symptoms in the patient's arm (positive test reproduction of pain)

distraction

test is a therapeutic maneuver used to alleviate symptoms of cervical radiculopathy. It involves gently pulling the head away from the neck to relieve pressure on the cervical spine, often decreasing pain in the arm (positive test is alleviation of pain/symptoms with test)

ULTT median

is a clinical test used to assess nerve tension of the median nerve in the upper limb. The maneuver involves a specific sequence of shoulder abduction (110 degrees), elbow extension, and wrist extension and finger extension, aiming to reproduce symptoms such as pain or tingling. (positive test is reproduction of pain with elbow extension)

ULTT Radial

is a clinical test used to assess nerve tension of the radial nerve in the upper limb. The maneuver involves shoulder abduction, elbow extension, wrist flexion, and shoulder internal rotation, aiming to reproduce symptoms such as pain or tingling (positive test is reproduction of pain with wrist flexion or shoulder extension).

ULTT Ulnar

is a clinical test used to assess nerve tension of the ulnar nerve in the upper limb. The maneuver involves shoulder abduction (45 degrees), elbow flexion, wrist extension, and shoulder external rotation, aiming to reproduce symptoms such as pain or tingling (positive test is reproduction of pain with elbow flexion).

VBI (vertebral artery basilar insufficiency)

is a clinical test used to evaluate vertebrobasilar insufficiency through specific head and neck positions (check 10 seconds extension, then 10 seconds contralateral rotation, then if those two don’t produce symptoms do extension plus ispilateral rotation for 10 seconds). It assesses signs of inadequate blood flow to the brain, which may indicate a risk of cerebrovascular events.

1st rib mobility

assesses the movement and function of the first rib.Clinician places patient's involved arm onto clinician's thigh. Clinician uses their other hand to rest on top of patient's opposite shoulder cradling the head. Clinician uses their second metatarsal head on the involved side to palpate patient's first rib, side bending the head towards, elevate clinician's elbow and a downward force is given to patient's first rib.

Suboccipital release/manual traction

is a manual therapy technique used to relieve tension/tone and discomfort in the suboccipital muscles at the base of the skull. The technique involves applying gentle traction or pressure to the cervical spine (from inferior to superior, can use massage lotion too) often aiding in the alleviation of headaches and neck pain.

relief with cervicoscapular muscle unloading

is a technique used to reduce tension in the cervicoscapular region by relieving strain on the muscles. This is achieved through specific positioning or manual techniques that offload the affected musculature (Placing one hand gently on the anterior shoulder to stabilize and the other hand on the scapula and elevate; re-assess resting pain and pain with active range of motion OR standing behind the patient, place hands under both axillas and elevate both shoulders, instruct patient to relax; re-assess resting pain and pain with active range of motion), often improving range of motion and reducing pain.

joint position error assessment

is a clinical test used to evaluate a patient's ability to accurately perceive joint position and movement (use laser on the head, have pt align it with the middle of target with eyes open, then close eyes and extend head and bring the head back to where they think the middle is. Measure where the laser point is then have the pt open eyes and realign, repeat). This assessment identifies proprioceptive deficits, often used in rehabilitation settings to gauge recovery and stability, particularly in the cervical spine.

cervical flexion with rotation

is a movement assessment technique used to evaluate cervical spine mobility and identify dysfunction. The is in supine and the clinician passively moves the patient into a flexion movement combined with rotation, allowing clinicians to assess the range of motion and any potential limitations or symptoms (positive test is a reproduction of pain or loss of rotation greater than 10 degrees- normal is 44 degrees rotation bilaterally)

cervical flexion/lateral rotation

the clinician moves the head passively into maximal rotation away from the affected side and then laterally flexes the neck. Test assesses the mobility of the 1st ribs, positive test is a firm or hard end feel or lack of range of motion

PA and unilateral PA glide

is manual therapy techniques applied to the spine, where the clinician uses their hands to provide a posterior-anterior (PA) or unilateral PA force on the spinous process or just lateral to the spinal process of the vertebrae. This technique aims to improve joint mobility, relieve pain, and enhance overall spinal function by targeting specific segments.

DNF endurance

is a measure of the strength and endurance of deep neck flexor muscles, essential for maintaining cervical stability. It assesses how long these muscles can sustain contraction without fatigue. the pt tucks the chin then lifts the head 2.5 inches off the table and holds as long as possible (norm without pain is 39 seconds, norm with pain is about 24 seconds)

sharp purser test

is a clinical test used to assess the integrity of the transverse ligament of the atlas. The clinician passively flexes the upper cervical spine then applies a posterior force to the forehead while stabilizing the C2 spinous process to check for excessive anterior translation of the atlas. positive test is abolishments of symptoms or a noticeable decrease in symptoms, indicating potential instability of the cervical spine.

shear test

is a clinical assessment used to evaluate the stability of the cervical spine by applying a shear force to the vertebrae. This test helps identify potential instability or dysfunction by assessing the integrity of surrounding ligaments and structures. pt is in supine, the clinician applies a lateral force through the skull while stabilizing the cervical spine to observe any abnormal movement or symptoms.

alar ligament test

is a clinical test used to assess the integrity of the alar ligaments, which connect the odontoid process of the axis to the occipital condyles. The clinician attempts to laterally flex the head while stabilizing the C2 vertebra to check for excessive motion, indicating possible instability of the atlantoaxial joint. Positive test is significant side bending with empty end feel, and spinous process does not come into fingers with side bending

bakody’s test

is a clinical test used to evaluate cervical radiculopathy. The patient is instructed to abduct the affected arm and place their hand on their head, which can alleviate symptoms, indicating potential nerve root compression.

which skills are used to address/screen neck pain with mobility deficits?

PA/unilateral PA glides, cervical flexion/lateral rotation, cervical flexion with lateral rotation, 1st rib mobility, suboccipital release/manual traction

which skills are used to address/screen neck pain with radicular symptoms?

spurling’s, distraction, bakody’s, ULTT median, ulnar, and radial

which skills are used to address/screen neck pain with motor control/WAD/Movement coordination?

sharp purser, alar ligament test, DNF endurance, craniocervical flexion test, shear test