Cervical Orthopedic Tests

Front 1

PRODECURE
Describe the procedure for Cervical Compression or Foraminal Compressin Test.

Back 1

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.

Front 2

MECHANISM/RATIONALE
What does the Cervical Compression test physically do?

Back 2

The downward pressure compresses the facets, vertebral bodies, disc, and narrow the IVF

Front 3

EXAM FINDINGS/INTERPRETATION
When performing the Cervical Compression test, what findings may result?

Back 3

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)

Front 4

After perferming the Cervical Compression test, what follow up procedures can be performed to further validate your diagnosis?

Back 4

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.

Front 5

How many cervical compression tests can be performed? Describe each procedure.

Back 5

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

Front 6

What is the other name for the Cervical Compression Test when the patient is in lateral flexion?

Back 6

Jackson's Test

Front 7

In the Cervical Compression Test with lateral flexion, where will joint and disc compression be more localized?

Back 7

To the side of lateral flexion (ipsilateral).

Front 8

In the Lateral Cervical Compression Test, what side will the IVF be narrowed?

Back 8

Ipsilaterally

Front 9

In the Cervical Compression Test with the head flexed forward, what part of the vertebral motor unit will experience increased load?

Back 9

the anterior part of the vertebral motor unit

Front 10

In the Cervical Compression Test with the head flexed forward, disc compression anteriorly may cause what posteriorly?

Back 10

Possible disc protrusion or prolapse may exacerbate radicular symptoms.

Front 11

Cervical Compression with the head extended will cause increased loading on what part of the vertebral motor unit?

Back 11

The posterior part

Front 12

On the cervical compression with the head extended where will disc compression occur, and what happens to the IVFs?

Back 12

Disc compression will occur on the posterior and the IVFs will narrow.

Front 13

On the cervical compression test with the head extended what symptoms may present?

Back 13

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.

Front 14

Maximum Cervical Compression Manuever

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

Back 14

The patient is seated

The doctor asks the patient to rotate the head and extend.

Front 15

What findings may be present on the Maximum Cervical Compression Test?

Back 15

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

Front 16

What follow up procedures can the doctor do after the Maximum Cervical Compression Test?

Back 16

1. Modified Spurlings
2. Cervical Distraction
3. Valsalva
4. Neurologic exam of sensory, motor, and reflex functions of the cervical spinal nerves.

Front 17

Describe the:
1. patient's position
2. position of patient's head
3. doctor position
4. doctor's prodecure

for the Spurling Test

Back 17

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

Front 18

Describe the:
1. patient's position
2. position of patient's head
3. doctor position
4. doctor's prodecure

for the MODIFIED Spurling Test

Back 18

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

Front 19

In Spurling or Modified Spurling tests, what findings might present?

Back 19

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

Front 20

What is the purpose of the Cervical Distraction Test?

Back 20

To see if decreased pressure on the cervical structures reduces pain.

Front 21

In the Cervical Distraction Test, what is the:
1. Patient Position
2. Doctor Position
3. Doctor Procedure
4. Exam findings/significance

Back 21

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)

Front 22

In the Cervical Distraction Test discomfort or pain can be produced in soft tissue. What might this suggest?

Back 22

A sprain or strain of the muscles and ligaments in the neck region.

Front 23

Shoulder Abduction Test (Bakody's Sign)

What is the:
1. Patient position
2. Patient procedure

Back 23

1. Seated
2. Patient is instructed to raise the painful extremity and place palm of hand on top of the head

Front 24

Shoulder Abduction Test (Bakody's Sign)

What does this procudure physically do to the spinal nerve?

Back 24

It reduces the traction of the compressed spinal nerve

Front 25

What are the positive findings for the Shoulder Abduction Test (Bakody's Sign)?

Back 25

A reduction of pain and paresthesia in the upper extremity

Front 26

Shoulder Abduction Test (Bakody's Sign)

If there is an exacerbation of pain/paresthesia during this test, what might this indicate?

Back 26

Pectoralis Minor (hyperabduction) sndrome

Front 27

What is the purpose of the Vasalva Maneuver?

Back 27

It increases intrathecal (CSF) pressure and helps to identify radiculopathy caused by a space occupying lesion.

Front 28

Describe the:

1. patient position
2. procedure

for the Valsalva Maneuver.

Back 28

1. Seated
2. examiner instruces patient to take a deep breath, hold it, and "bear down" as if to move their bowels.

Front 29

What are positive findings for the Valsalva Maneuver?

Back 29

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).

Front 30

When a patient performs the Vasalva Maneuver, what is the more positive finding?

Back 30

radiation into the upper extremity is a more positive finding than exacerbation of local cervical pain

Front 31

A positive Vasalva maneuver may be indicative of what triad?

Back 31

Dejerine's Triad

Front 32

What is Dejerine's Triad?

Back 32

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.

Front 33

Describe the doctor procedure for the Naffzigger (Juggular Compression) Test.

Back 33

The doctor compresses the patients jugular veins on both sides of the neck.

Front 34

What does the Naffzigger (Juggular Compression) Test do?

Back 34

It increases intrathecal pressure by "backing up" venous drainage.

Front 35

What is the Naffzigger (Juggular Compression) Test used to determine?

Back 35

If it exacerbates or aggravates upper extremity pain and paresthesia, it suggests a space occupying lesion or stenosis

Front 36

Who is the Naffzigger (Juggular Compression) Test contraindicated for?

Back 36

Geriatric patients, as light headedness and dizziness may ensure. Caution should be taken for patients with atherosclerosis.

Front 37

What is the Shoulder Depression Test used for?

Back 37

It tests for nerve root dural sleeve adhesions.

Front 38

When aggravation of pain and paresthesia occurs during the Shoulder Depression Test, what does this indicate?

Back 38

It indicates nerve root dural sleeve adhesions.

Front 39

During the Shoulder Depression Test, what other problems can be aggravated?

Back 39

Aggravation of muscle spasms, or strain/sprain of the mucles and ligaments.

Front 40

During the Shoulder Depression Test, depression of the clavicle may cause what?

Back 40

A narrowing the the costoclavicular space may cause upper extremity pain, indicating costoclavicular syndrome.

Front 41

During Naffzigger's Test, how long does the doctor compress the jugular veins?

Back 41

30-45 seconds

Front 42

On Naffziggers, what should you make sure not to compress?

Back 42

The Carotid arteries

Front 43

For the Lhermitte's Sign test, what is the patient procedure?

Back 43

Patient actively (without doctor assistance) flexes the head toward the chest.

Front 44

A positive finding for Lhermitte's sign is what?

Back 44

a sharp pain down the spine and into the upper or lower extremities

Front 45

If a positive sign is indicated during Lhermitte's Sign, what might the specific causes?

Back 45

1. Multiple Sclerosis
2. Myelopathy (associated with cervical spondylosis and spinal canal stenosis)
3. Disc protrusion/prolapse
4. tumor