Cervical Spine Tests + Mobilizations

what 3 TESTS are used for assessing UPPER CERVICAL STABILITY

1. Sharp-Purser Test

2. Alar Ligament Test

3. Transverse Ligament Test

Sharp-Purser Test

Purpose: to determine subluxation of atlas on axis

Testing Procedure:

1. patient seated

2. passively flex head + neck to 20-30 degrees + assess for any symptoms

3. place one hand on the forehead

4. stabilize C2 with other hand using a pincer grasp

5. examiner applies a posteriorly-directed translation force (to avoid capital extension) through forehead

Positive Sign:

1. backwards cranial movement without axis moving

- indicates: reduction of a subluxed atlas

2. myelopathic symptoms decrease

3. audible clunk

what is the PURPOSE of the SHARP-PURSER TEST

to determine subluxation of atlas on axis

what are the 5 STEPS of the SHARP-PURSER TEST

1. patient seated

2. passively flex head + neck to 20-30 degrees + assess for any symptoms

3. place one hand on the forehead

4. stabilize C2 with other hand using a pincer grasp

5. examiner applies a posteriorly-directed translation force (to avoid capital extension) through forehead

what are 3 POSITIVE SIGNS of the SHARP-PURSER TEST

1. backwards cranial movement without axis moving

- indicates: reduction of a subluxed atlas

2. myelopathic symptoms decrease

3. audible clunk

Alar Ligament Test

Testing Procedure:

1. patient is supine/seated

2. stabilize C2 between thumb + index finger

3. use other hand to sidebend the head

4. should feel C2 spinous process move immediately into your finger in opposite direction

Positive Sign: delay in movement of spinous process

what are the 4 STEPS of the ALAR LIGAMENT TEST

1. patient is supine/seated

2. stabilize C2 between thumb + index finger

3. use other hand to sidebend the head

4. should feel C2 spinous process move immediately into your finger in opposite direction

what is the POSITIVE SIGN of the ALAR LIGAMENT TEST

delay in movement of the spinous process

Transverse Ligament Test

Purpose: to test integrity of the transverse ligament

Testing Procedure:

1. patient supine

2. support occiput with index finger in space between occiput + C2

3. lift head + C1 carefully anterior together without FB or BB

4. hold for 10-20 seconds

Positive Sign:

1. soft end feel

2. muscle spasm

3. nystagmus

4. lump sensation in throat

what is the PURPOSE of the TRANSVERSE LIGAMENT TEST

to test for integrity of transverse ligament

what are the 4 STEPS of the TRANSVERSE LIGAMENT TEST

1. patient supine

2. support occiput with index finger in space between occiput + C2

3. lift head + C1 carefully anterior together without FB or BB

4. hold for 10-20 seconds

what are 4 POSITIVE SIGNS of the TRANSVERSE LIGAMENT TEST

1. soft end feel

2. muscle spasm

3. nystagmus

4. lump sensation in throat

what 2 SPECIAL TESTS are used for assessing for *VBI (Vertebrobasilar Insufficiency)

1. vertebral artery

2. pre-manipulative hold

VBI Testing

Purpose: to test for VBI

Testing Procedure:

1. patient is asked about signs + symptoms of VBI

- if definitive VBI symptoms -> referred out

2. perform end-range cervical rotation test

- position held for 10 seconds

- observation of VBI signs + symptoms

3. return head to neutral position + held for minimum of 10 seconds

4. perform body on head rotation test

Positive Sign: onset of VBI symptoms

what is the PURPOSE of VBI TESTING

to test for VBI

what are the 4 STEPS included in VBI TESTING

1. patient is asked about signs + symptoms of VBI

- if definitive VBI symptoms -> referred out

2. perform end-range cervical rotation test

- position held for 10 seconds

- observation of VBI signs + symptoms

3. return head to neutral position + held for minimum of 10 seconds

4. perform body on head rotation test (hold for 4 seconds)

- used to differentiate b/w VBI or vestibular

what is the POSITIVE SIGN associated with VBI TESTING

onset of VBI symptoms

VBI Testing: Pre-Manipulative Hold

Purpose: to test for VBI before manipulation

Testing Procedure:

1. pt in supine position

2. rotate + extend pt's head + hold position for 10 seconds

Positive Sign: onset of VBI symptoms

what is the PURPOSE of the PRE-MANIPULATIVE HOLD

to test for VBI before manipulation

what are the 2 STEPS of the PRE-MANIPULATIVE HOLD

1. pt in supine position

2. rotate + extend pt's head + hold position for 10 seconds

what is a POSITIVE SIGN associated with PRE-MANIPULATIVE HOLD

onset of VBI symptoms

what 3 SPECIAL TESTS are used for assessing for CERVICAL MYELOPATHY

1. Hoffman's reflex

2. Inverted Supinator

3. Babinski Sign

Hoffman's Reflex Test

Testing Procedure:

1. patient is sitting or standing

2. stabilize middle finger proximal to DIP

3. flick middle finger nail

Positive Sign: adduction + opposition of thumb + slight flexion of fingers

what are the 3 STEPS of the HOFFMAN'S REFLEX TEST

1. patient is sitting or standing

2. stabilize middle finger proximal to DIP

3. flick middle finger nail

what is the POSITIVE SIGN of the HOFFMAN'S REFLEX TEST

adduction + opposition of thumb + slight flexion of fingers

Inverted Supinator Test

Testing Procedure:

1. patient seated facing clinician

2. patient places slightly pronated forearm on examiner's forearm for relaxation

3. clinician applies a quick series of strikes near radial styloid area over brachioradialis tendon

Positive Sign: rapid finger flexion or slight elbow extension

what are the 3 STEPS of the INVERTED SUPINATOR TEST

1. patient seated facing clinician

2. patient places slightly pronated forearm on examiner's forearm for relaxation

3. clinician applies a quick series of strikes near radial styloid area over brachioradialis tendon

what is the POSITIVE SIGN of the INVERTED SUPINATOR TEST

rapid finger flexion or slight elbow extension

what is the POSITIVE SIGN associated with the BABINSKI SIGN

great toe extension + separation

what are the 5 TEST ITEM CLUSTER for CERVICAL MYELOPATHY

1. gait deviations

2. positive Hoffman

3. positive inverted supinator

4. positive Babinski

5. age >45 years old

what 4 TESTS are used for assessing for CERVICAL RADICULOPATHY

1. Spurling's A + B

2. Shoulder Abduction Relief Test

3. Distraction Test

4. ULTT A: median nerve bias test

what are the 4 TEST ITEM CLUSTER for CERVICAL RADICULOPATHY

1. Spurling's A (lateral flexion + compression)

2. ULTT A (median nerve bias test

3. distraction test (supine, chin grasp)

4. <60 degrees ipsilateral rotation

what SPURLING TEST is the MAIN TEST for nerve root symptoms (radiculopathy)

Spurling's A

Spurling's A

Purpose: test for nerve root symptoms (radiculopathy)

Testing Procedure: ipsilateral SB + compression

Positive Sign: increased in radicular signs

what are the 2 MOTIONS required to perform SPURLING'S A

1. ipsilateral SB

2. compression

Spurling's B

Purpose: test for nerve root symptoms (radiculopathy)

Testing Procedure: ipsilateral SB + extension + compression (overpressure)

Positive Sign: increased in radicular signs

what are the 3 MOTIONS required to perform SPURLING'S B

1. ipsilateral SB

2. extension

3. compression (overpressure)

what is the PURPOSE of SPURLING'S A + B

test for nerve root symptoms (radiculopathy)

what is the POSITIVE SIGN for SPURLING'S A + B

increase in radicular signs

Shoulder Abduction Relief Test

Testing Procedure:

1. instruct pt to place hand of affected extremity on their head

- to support the UE in the scapular place

Positive Sign: alleviation of radicular symptoms

how is the SHOULDER ABDUCTION RELIEF TEST performed

instruct pt to place hand of affected extremity on their head

(in order to support UE in scapular place)

what is the POSITIVE SIGN associated with the SHOULDER ABDUCTION RELIEF TEST

alleviation of radicular symptoms

what TYPE of TREATMENT is the SHOULDER ABDUCTION RELIEF TEST classified as

traction treatment

Distraction Test

Purpose: test for nerve root symptoms (radiculopathy)

Testing Procedure:

1. place one hand under pt's chin + other hand under occiput

- if TMJ issues: do suboccipital grasp

2. slowly distract with slight flexion

3. hold for 10-15 seconds

Positive Sign: decrease in radicular signs

what is the PURPOSE of the DISTRACTION TEST

test for nerve root symptoms (radiculopathy)

what are the 3 STEPS of the DISTRACTION TEST

1. place one hand under pt's chin + other hand under occiput

- if TMJ issues: do suboccipital grasp

2. slowly distract with slight flexion

3. hold for 10-15 seconds

what is the POSITIVE SIGN of the DISTRACTION TEST

decrease in radicular signs

Valsalva Maneuver

Purpose: to assess for cervical radiculopathy

Testing Procedure: ask patient when doing subjective if they have any problems with coughing or sneezing

Positive Sign:

- YES = dis problem or cervical radiculopathy

what is the PURPOSE of VALSALVA MANEUVER

to assess for cervical radiculopathy

what TEST is used for HEADACHE IMPAIRMENT

flexion rotation test

Flexion Rotation Test

Purpose: to test for upper cervical mobility headache impairment (cervicogenic HA)

Testing Procedure:

1. PT/examiner at head of table

2. assess resting symptoms

3. pt completes active full neck flexion

- to isolate C1 + C2

4. PT applies passive full rotation to both sides while assessing symptoms

Positive Sign:

1. either pain provocation or loss of 10 degrees relative to other side

what is the PURPOSE of the FLEXION ROTATION TEST

to test for upper cervical mobility headache impairment (cervicogenic HAs)

what are the 4 STEPS of the FLEXION ROTATION TEST

1. PT/examiner at head of table

2. assess resting symptoms

3. pt completes active full neck flexion

- to isolate C1 + C2

4. PT applies passive full rotation to both sides while assessing symptoms

what is the POSITIVE SIGN of the FLEXION ROTATION TEST

1. pain provocation

OR

2. loss of 10 degrees relative to other side

Neck Flexor Endurance Test

Purpose: to assess anterior, deep neck flexor endurance

Testing Procedure:

1. pt in supine/hooklying position

2. pt retracts chin (full retraction)

3. PT lifts pt's head (1 inch)

4. PT maintains hand position under pt's head

5. PT draws line on anterolateral neck skinfolds

6. pt instructed to hold chin tuck position + PT places hand under pt's head without touching

7. if pt's head touches PT's hand or skinfold is lost, PT instructs pt to correct

Test Terminated: pt cannot hold position or maintain skinfolds for >1 sec

Norms:

- Female: 29 seconds

- Male: 39 seconds

what is the PURPOSE of the NECK FLEXOR ENDURANCE TEST

to assess anterior, deep neck flexor endurance

what are the 7 STEPS of the NECK FLEXOR ENDURANCE TEST

1. pt in supine/hooklying position

2. pt retracts chin (full retraction)

3. PT lifts pt's head (1 inch)

4. PT maintains hand position under pt's head

5. PT draws line on anterolateral neck skinfolds

6. pt instructed to hold chin tuck position + PT places hand under pt's head without touching

7. if pt's head touches PT's hand or skinfold is lost, PT instructs pt to correct

when is the NECK FLEXOR ENDURANCE TEST terminated

when pt cannot hold position or maintain skinfolds for >1 sec

what are the NORMS of the NECK FLEXOR ENDURANCE TEST

- Female: 29 seconds

- Male: 39 seconds

what is the POSITIVE SIGN of QUADRANT TESTING

pain provocation

regarding QUADRANT TESTING, what QUADRANT provides MAXIMAL FORAMINAL CLOSURE

extension quadrant

during QUADRANT TESTING, what can be APPLIED for PROVOCATION

compression

what are the 4 TYPES of QUADRANT TESTING

1. flexion, LSB, LR

2. flexion, RSB, RR

3. extension, LSB, LR

4. extension, RSB, RR

when should QUADRANT TESTING be completed

at the end of session due to being most provocative

what are 4 TESTS used for THORACIC OUTLET SYNDROME

1. Allen's test

2. Adson Maneuver

3. Halstead Maneuver

4. Roos Test

Allen's Test

Purpose: to assess blood flow to the hand through radial + ulnar arteries

Testing Procedure:

1. pt is seated

2. pt clenches fist tightly for 30 seconds

3. PT simultaneously compresses both radial + ulnar arteries at the wrist

4. pt opens their hand

5. observe color of palm + fingers

6. release pressure on ulnar artery, but keep pressure on radial artery

7. pt opens + closes their hand several times

8. observe color

Results:

- if the hand returning to normal color (flushing) with 5-15 seconds: ulnar artery has good blood flow

what is the PURPOSE of ALLEN'S TEST

to assess blood flow to the hand through radial + ulnar arteries

what are the 8 STEPS of the ALLEN'S TEST

1. pt is seated

2. pt clenches fist tightly for 30 seconds

3. PT simultaneously compresses both radial + ulnar arteries at the wrist

4. pt opens their hand

5. observe color of palm + fingers

6. release pressure on ulnar artery, but keep pressure on radial artery

7. pt opens + closes their hand several times

8. observe color

regarding ALLEN'S TEST, what does it indicate if it takes the hand 5-15 seconds to return to normal color (flushing)

ulnar artery has good blood flow

Adson Maneuver

Purpose: to assess for thoracic outlet syndrome

Testing Procedure:

1. pt is seated

2. elbow fully extended

3. abduct pt's arm 30 degrees at the shoulder

4. palpate the radial pulse

5. have pt extend their neck + turn their head toward the affected side

6. have pt take a deep breath in + out

7. compare radial pulse to the resting pulse

Positive Sign: decrease or disappearance of radial pulse

what is the PURPOSE of the ADSON MANEUVER

to assess for thoracic outlet syndrome

what are the 7 STEPS of ADSON MANEUVER

1. pt is seated

2. elbow fully extended

3. abduct pt's arm 30 degrees at the shoulder

4. palpate the radial pulse

5. have pt extend their neck + turn their head toward the affected side

6. have pt take a deep breath in + out

7. compare radial pulse to the resting pulse

what is the POSITIVE SIGN of the ADSON MANEUVER

decrease or disappearance of radial pulse

Halstead Maneuver ("Reverse Adson's Test)

Purpose: to assess for thoracic outlet syndrome

Testing Procedure:

1. pt is seated

2. PT palpates radial pulse

3. abduct pt's arm to 45 degrees

4. extend the shoulder to 45 degrees

5. externally rotate arm while applying a downward distraction

6. pt turn head away from side being testing + extend their cervical spine

Positive Sign:

1. significant reduction or absence of radial pulse on affected side compared to unaffected side

OR

2. if pt experiences symptoms

what is the PURPOSE of the HALSTEAD MANEUVER

to assess for thoracic outlet syndrome

what are the 6 STEPS of the HALSTEAD MANEUVER

1. pt is seated

2. PT palpates radial pulse

3. abduct pt's arm to 45 degrees

4. extend the shoulder to 45 degrees

5. externally rotate arm while applying a downward distraction

6. pt turn head away from side being testing + extend their cervical spine

what are the 2 POSITIVE SIGNS of the HALSTEAD MANEUVER

1. significant reduction or absence of radial pulse on affected side compared to unaffected side

OR

2. if pt experiences symptoms

Roos Test

Purpose: to assess for thoracic outlet syndrome

Testing Procedure:

1. pt is seated

2. have pt abduct arms to 90 degrees

3. then externally rotate + flex elbow to 90 degrees

4. instruct pt to open + close hands fro 3 minutes

Positive Sign: reproduction of symptoms

what is the PURPOSE of the ROOS TEST

to assess for thoracic outlet syndrome

what are the 4 STEPS of the ROOS TEST

1. pt is seated

2. have pt abduct arms to 90 degrees

3. then externally rotate + flex elbow to 90 degrees

4. instruct pt to open + close hands fro 3 minutes

what is the POSITIVE SIGN of the ROOS TEST

reproduction of symptoms

what TEST is used for assessing FIRST RIB MOBILITY

cervical rotation lateral flexion test

Cervical Rotation Lateral Flexion Test

Purpose: to assess for 1st rib impairment

Testing Procedure:

1. patient is seated

2. PT passively rotates spine to end range rotation

3. maintaining rotation, passively flex the spine into opposite side bending

Positive Sign: significant limitation with a hard or abrupt end feel compared to contralateral side

what is the PURPOSE of the CERVICAL ROTATION LATERAL FLEXION TEST

to assess for 1st rib impairment

what are the 3 STEPS of the CERVICAL ROTATION LATERAL FLEXION TEST

1. patient is seated

2. PT passively rotates spine to end range rotation

3. maintaining rotation, passively flex the spine into opposite side bending

what is the POSITIVE SIGN of the CERVICAL ROTATION LATERAL FLEXION TEST

significant limitation with a hard or abrupt end feel compared to contralateral side

what are the 3 UPPER LIMB TENSION TESTS

1. ULTT A (Median Nerve)

2. ULTT B (Radial Nerve)

3. ULTT C (Ulnar Nerve)

what are 3 POSITIVE SIGNS of the UPPER LIMB TENSION TESTS

1. reproduction of symptoms

2. asymmetrical resistance or symptoms compared to uninvolved limb

3. symptoms change with neck movements

what is the PURPOSE of the PASSIVE INTERVERTEBRAL MOTION CERVICAL + UPPER THORACIC SPINE

to assess passive intervertebral motion (PIVM) with FB, BB, SB + rotation in cervical + upper thoracic spine

what 3 CERVICAL MOB TECHNIQUES are used for JOINT PLAY/MOBILIZATIONS

1. cervical down glide

2. cervical lateral glide

3. OA joint mobility (unilateral)

what are 2 PURPOSES of CERVICAL DOWN GLIDE

1. to assess passive intervertebral motion with down gliding of cervical facets

2. to improve motion with ipsilateral cervical side bending

what are 2 PURPOSES of CERVICAL LATERAL GLIDE

1. to assess passive intervertebral motion with lateral gliding of cervical facets

2. to improve motion with ipsilateral cervical side bending

what is the PURPOSE of OA JOINT MOBILITY

to assess OA accessory mobility unilaterally/bilaterally

what 2 CERVICAL MOB TECHNIQUES is used for JOINT PLAY ASSESSMENT

1. AA joint mobility

2. OA joint mobility (bilaterally)

what is the PURPOSE of AA JOINT MOBILITY

to assess AA mobility bilaterally

what are 3 CERVICAL MOB TECHNIQUES used for JOINT MOBILIZATION

1. cervical up glide

2. suboccipital release

3. manual traction

what is the PURPOSE of CERVICAL UP GLIDE

to improve motion with cervical facet up glide

what is CERVICAL UP GLIDE also viewed as

soft tissue mobilization + joint mobilization

what is the PURPOSE of SUBOCCIPITAL RELEASE

inhibitive technique for subcranial musculature + joint structures

what is the PURPOSE of MANUAL TRACTION

to improve facet joint mobility + increased patency of lateral cervical foramen