Clinical Techniques and Assessment II: Special Tests - Spine

Special Tests for Spine

Introduction

• Focus on special tests used in clinical assessment of the cervical and thoracic spine.

Cervical Spine Special Tests

1. Distraction Test

• Purpose: Tests for nerve root compression.
• Positive Sign: Decreased pain when traction is applied.
• Method:
  • Therapist places one hand under the patient's chin and the other cradling the occiput.
  • Slowly lift the patient's head to traction the cervical spine.

2. Spurling/Foraminal Compression Test

• Purpose: Identifies nerve root compression.
• Positive Sign: Pain radiating into the arm on the affected side, increased neurological symptoms.
  • Identify the affected dermatome through pain pattern.
• Method:
  • Patient sidebends cervical spine towards the unaffected side first.
  • Therapist applies straight downward pressure on the head.

3. Jackson Compression Test

• Purpose: Tests for nerve root compression.
• Positive Sign: Symptoms similar to Spurling's test.
• Method:
  • Patient rotates their cervical spine towards the unaffected side first.
  • Therapist applies straight downward pressure on the head.

4. Maximum Cervical Compression Test

• Purpose: Assesses nerve root compression or facet joint pathology.
• Positive Sign: Symptoms as in Spurling's and Jackson's tests; pain on the convex side indicates muscle strain.
• Method:
  • Patient side flexes, rotates to the same side, and extends the cervical spine.
  • Therapist applies pressure on the head.

5. Scalene Cramp Test

• Purpose: Identifies scalene trigger points.
• Positive Sign: Increased pain due to scalene trigger points of the side rotated toward.
• Method:
  • Patient rotates head towards the affected side and pulls chin towards the clavicle.

6. Shoulder Abduction/Relief Test (Brakody’s Sign)

• Purpose: Tests for nerve root irritation primarily at C4/C5.
• Positive Sign: Decrease or relief of symptoms when arm is abducted.
• Method:
  • Therapist passively abducts the client’s arm to rest on top of the head.

7. Shoulder Depression Test

• Purpose: Assesses brachial plexus compression/irritation.
• Positive Sign: Increased pain and neurological symptoms.

8. Vascular Testing: Vertebral Artery Test

• Purpose: Tests for vertebral artery compression.
• Positive Sign: Nystagmus, dizziness, visual disturbances.
• Method:
  • Client lies supine; therapist rotates and extends the head while monitoring for symptoms.

9. Hautant’s Test

• Purpose: Differentiates between dizziness caused by articular problems and vascular problems.
• Method:
  • Step 1: Patient flexes arms to 90 degrees, closes eyes for 10-30 seconds.
  • Loss of arm position = potential vascular issue.
  • Step 2: Patient rotates and extends neck while observing for loss of arm position.

10. Valsalva’s Maneuver

• Purpose: Tests for space-occupying lesions (herniated disc, tumors).
• Positive Sign: Increased pain indicating pressure on the spinal cord.
• Method: Patient holds breath and bears down as if blowing up a balloon.

Thoracic Spine Special Tests

1. 1st Rib Mobility Test

• Purpose: Tests for hypomobility of the 1st rib.
• Positive Sign: Difference in movement or pain on affected side.
• Method:
  • Palpate the first rib; client takes deep breaths while therapist assesses movement.

2. Neuro Testing: 1st Thoracic Nerve Root Stretch (Bikle’s Sign)

• Purpose: Tests T1 nerve root/ulnar nerve.
• Positive Sign: Pain radiating into scapular area or arm.
• Method: Client abducts arm to 90 degrees, flexes elbow with forearm behind the neck.

3. Passive Scapular Approximation Test

• Purpose: Tests T1/T2 nerve root impingement.
• Positive Sign: Pain in the scapular area.
• Method: Therapist approximates scapula while patient is prone or sitting.

4. Slump Test

• Purpose: Tests for impingement of dura, spinal cord, or nerve roots.
• Positive Sign: Neurological symptoms such as sciatica or electric nerve pain.
• Method: Client slumps forward, chin to chest, therapist applies overpressure. Extend one knee and dorsiflex foot to provoke symptoms.

5. Kemp’s (Quadrant) Test

• Purpose: Evaluates facet joint and nerve root compression.
• Positive Sign: Local pain on facet side, neuro symptoms indicate nerve root involvement.
• Method: Client stands, therapist directs them to extend, sidebend, and rotate while applying overpressure.

Conclusion

• Familiarize with these special tests for evaluating different pathologies related to the cervical and thoracic spine. Understanding positive signs and appropriate methods is crucial for effective assessment and diagnosis.