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45 Cards in this Set

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PRODECURE
Describe the procedure for Cervical Compression or Foraminal Compressin Test.
1. Patient is seated
2. Doctor stands behind patient and placeds both hands on top of head
3. Doctor applies grandually increasing pressure straight down to compress the cervical spine
4.
MECHANISM/RATIONALE
What does the Cervical Compression test physically do?
The downward pressure compresses the facets, vertebral bodies, disc, and narrow the IVF
EXAM FINDINGS/INTERPRETATION
When performing the Cervical Compression test, what findings may result?
1. Creation or exacerbation of local or diffuse cervical spine pain suggests joint involvement (subluxation, DJD, or trauma).

Note: Ill defined, diffuse pain into the shoulder or arm may be present due to sclerogenic referral.

2. Creation or exacerbation of pain, tingling, and numbness in the upper extremity (especially in a dermotomal distribution) suggests cervical radiculopathy (space occupying lesion, eg. tumor or disc prolapse, or stenosis)
After perferming the Cervical Compression test, what follow up procedures can be performed to further validate your diagnosis?
The doctor can do varations of the compression test, perform the Cervical Distraction test, Valsalva; neurological exam of the sensory, motor, and reflex functions of the cervical spinal nerves.
How many cervical compression tests can be performed? Describe each procedure.
Seven
- cervical compression precedures -
1. Press straight down with both hands on top of head
2. Press straight down while patient has head lateral flexed to the left (Jackson's Test)
3. Press straight down while patient has head laterally flexed to the right (Jackson's Test)
4. Press straight down while patient has head in forward flexion
5. Press straight down while patient has head in extension
6. Press straight down while patient has head in right rotation
7. Press straight down while patient has head in left rotation
What is the other name for the Cervical Compression Test when the patient is in lateral flexion?
Jackson's Test
In the Cervical Compression Test with lateral flexion, where will joint and disc compression be more localized?
To the side of lateral flexion (ipsilateral).
In the Lateral Cervical Compression Test, what side will the IVF be narrowed?
Ipsilaterally
In the Cervical Compression Test with the head flexed forward, what part of the vertebral motor unit will experience increased load?
the anterior part of the vertebral motor unit
In the Cervical Compression Test with the head flexed forward, disc compression anteriorly may cause what posteriorly?
Possible disc protrusion or prolapse may exacerbate radicular symptoms.
Cervical Compression with the head extended will cause increased loading on what part of the vertebral motor unit?
The posterior part
On the cervical compression with the head extended where will disc compression occur, and what happens to the IVFs?
Disc compression will occur on the posterior and the IVFs will narrow.
On the cervical compression test with the head extended what symptoms may present?
1. Radicular symptoms may exacerbate when IVF stenosis is present

2. Radicular symptoms due to a disc protrusion or prolapse may be reduced, because the disc may be displaced anteriorly.
Maximum Cervical Compression Manuever

What is the patient position? What does the doctor ask the patient to do?
The patient is seated

The doctor asks the patient to rotate the head and extend.
What findings may be present on the Maximum Cervical Compression Test?
Exacerbation of pain with local or diffuse pain suggests subluxation, DJD, or trauma.

Exacerbation of pain with radicular pain, numbness, or tingling in a dermotomal pattern suggest space occupying lesion (disc protrusion/prolapse, tumor, osteophytes) or IVF stenosis
What follow up procedures can the doctor do after the Maximum Cervical Compression Test?
1. Modified Spurlings
2. Cervical Distraction
3. Valsalva
4. Neurologic exam of sensory, motor, and reflex functions of the cervical spinal nerves.
Describe the:
1. patient's position
2. position of patient's head
3. doctor position
4. doctor's prodecure

for the Spurling Test
1. patient seated
2. rotated and extended
3. behind patient with one hand on top of head
4. doctor delivers a vertical blow to the top of the patient's head
Describe the:
1. patient's position
2. position of patient's head
3. doctor position
4. doctor's prodecure

for the MODIFIED Spurling Test
1. Patient seated
2. Rotated and extended
3. standing behind seated patient
4. with both hands clasped at the fingers atop patients head, doctor applies gradually increasing pressure to compress the cervical spine
In Spurling or Modified Spurling tests, what findings might present?
1. Exacerbation of local or diffuse pain may indicate joint involvement, including subluxation, DJD, or trauma

Note: Diffuse/local pain into the shoulder or arm may be present due to sclerogenic referral.

2. Exacerbation of pain, tingling or numbness in the upper extremity, especially in a dermotomal pattern suggests a radiculopathy caused by a space occupying lesion (tumor, osteophytes, disc protrusion or prolapse), or IVF stenosis
What is the purpose of the Cervical Distraction Test?
To see if decreased pressure on the cervical structures reduces pain.
In the Cervical Distraction Test, what is the:
1. Patient Position
2. Doctor Position
3. Doctor Procedure
4. Exam findings/significance
1. Seated
2. At the side of the patient
3. Doctor places one hand under the patient's chin and the other hand at the base of the patient's occiput (there are other hand positions too)
4. Decreased local/diffuse pain suggests positive finding for subluxation, DJD, or trauma. Decreased pain, tingling or numbness in the upper extremity suggests cervical radiculopathy (tumor, IVF stenosis, disc protrusion/prolapse)
In the Cervical Distraction Test discomfort or pain can be produced in soft tissue. What might this suggest?
A sprain or strain of the muscles and ligaments in the neck region.
Shoulder Abduction Test (Bakody's Sign)

What is the:
1. Patient position
2. Patient procedure
1. Seated
2. Patient is instructed to raise the painful extremity and place palm of hand on top of the head
Shoulder Abduction Test (Bakody's Sign)

What does this procudure physically do to the spinal nerve?
It reduces the traction of the compressed spinal nerve
What are the positive findings for the Shoulder Abduction Test (Bakody's Sign)?
A reduction of pain and paresthesia in the upper extremity
Shoulder Abduction Test (Bakody's Sign)

If there is an exacerbation of pain/paresthesia during this test, what might this indicate?
Pectoralis Minor (hyperabduction) sndrome
What is the purpose of the Vasalva Maneuver?
It increases intrathecal (CSF) pressure and helps to identify radiculopathy caused by a space occupying lesion.
Describe the:

1. patient position
2. procedure

for the Valsalva Maneuver.
1. Seated
2. examiner instruces patient to take a deep breath, hold it, and "bear down" as if to move their bowels.
What are positive findings for the Valsalva Maneuver?
Production or exacerbation of pain in the neck, or a radicular pain or paresthesia radiating into the upper extremity suggests stenosis, space occupying lesion (tumor, disc prolapes/protrusion, osteophytes).
When a patient performs the Vasalva Maneuver, what is the more positive finding?
radiation into the upper extremity is a more positive finding than exacerbation of local cervical pain
A positive Vasalva maneuver may be indicative of what triad?
Dejerine's Triad
What is Dejerine's Triad?
When a patient coughs, sneezes, or strains to go to the bathroom, while at the same time experiencing pain, tingling, numbness in a dermotomal pattern.
Describe the doctor procedure for the Naffzigger (Juggular Compression) Test.
The doctor compresses the patients jugular veins on both sides of the neck.
What does the Naffzigger (Juggular Compression) Test do?
It increases intrathecal pressure by "backing up" venous drainage.
What is the Naffzigger (Juggular Compression) Test used to determine?
If it exacerbates or aggravates upper extremity pain and paresthesia, it suggests a space occupying lesion or stenosis
Who is the Naffzigger (Juggular Compression) Test contraindicated for?
Geriatric patients, as light headedness and dizziness may ensure. Caution should be taken for patients with atherosclerosis.
What is the Shoulder Depression Test used for?
It tests for nerve root dural sleeve adhesions.
When aggravation of pain and paresthesia occurs during the Shoulder Depression Test, what does this indicate?
It indicates nerve root dural sleeve adhesions.
During the Shoulder Depression Test, what other problems can be aggravated?
Aggravation of muscle spasms, or strain/sprain of the mucles and ligaments.
During the Shoulder Depression Test, depression of the clavicle may cause what?
A narrowing the the costoclavicular space may cause upper extremity pain, indicating costoclavicular syndrome.
During Naffzigger's Test, how long does the doctor compress the jugular veins?
30-45 seconds
On Naffziggers, what should you make sure not to compress?
The Carotid arteries
For the Lhermitte's Sign test, what is the patient procedure?
Patient actively (without doctor assistance) flexes the head toward the chest.
A positive finding for Lhermitte's sign is what?
a sharp pain down the spine and into the upper or lower extremities
If a positive sign is indicated during Lhermitte's Sign, what might the specific causes?
1. Multiple Sclerosis
2. Myelopathy (associated with cervical spondylosis and spinal canal stenosis)
3. Disc protrusion/prolapse
4. tumor