Orthopedic Tests - Cervical Spine

Front 1

Vertebral Artery (Quadrant Test)
Testing For:
Procedure:
Positive Sign:

Back 1

Testing for: Ischemia or circulation deficiency of the vertebral artery at the transverse foramen
Procedure: Client supine - eyes open - client actively rotates the head fully to one side, then extends the neck - hold for 30 seconds - do same on other side
Positive sign: Client complains of dizziness, nystagmus, or both (no further testing, refer to doctor)

Front 2

Swallowing test
Testing For:
Procedure:
Positive Sign:

Back 2

Testing for: to see if cause of pain when swallowing is trigger points on the SCM
Procedure: Client seated - palpate and pincer grasp SCM, locate tender point, place firm pressure and have client swallow
Positive sign: pain diminishes when client swallows as you pincer grasp the most tender point; otherwise, pain can be caused by throat infection, hematoma, bony protuberance of CS or tumor (see doctor)

Front 3

Valsalva Maneuver
Testing For:
Procedure:
Positive Sign:

Back 3

Testing for: determine the effect of increased pressure on the spinal cord
Procedure: client seated - patient takes a deep breath and places thumb in mouth and pretend to blow a balloon
Positive sign: increased pain due to increased pressure within the spinal cord occurring from lesions such as herniated disc, tumor, stenosis, osteophytes

Front 4

Backward Bending Test
Testing For:
Procedure:
Positive Sign:

Back 4

Testing for: vertebrobasilar artery insufficiency
Procedure: client supine - eyes open - clients head is supported by therapist - clients head is brought into full backwards bending 8-12 seconds
Positive signs: faintness, dizziness, nystagmus and personality changes which indicate pressure on vertebral arteries

Front 5

Maigne`s Test
Testing For:
Procedure:
Positive Sign:

Back 5

Testing for: vertebrobasilar artery insufficiency
Procedure: client supine - eyes open - clients head is supported by therapist - clients head is brought into full backwards bending and rotation - held for 15 sec
Positive signs: faintness, dizziness, nystagmus and personality changes which indicate pressure on vertebral arteries

Front 6

Hautant`s Test
Testing For:
Procedure:
Positive Sign:

Back 6

Testing for: vertebrobasilar artery insufficiency and differentiate dizziness or vertigo
Procedure: client is seated - both arms extended to 90 degrees - eyes closed - position held for 10 sec
Positive signs: if loss of arm position = non vascular; then client places head in extension and rotation and if arms waver, the cause is vascular impairment

Front 7

Alar Ligament Test (Lateral Flexion)
Testing For:
Procedure:
Positive Sign:

Back 7

Testing for: reveals rupture of the alar ligament or fracture of the odontoid process of C2
Procedure: client supine with head in neutral position - therapist stabilizes the axis with a wide pinch grip around the spinous process and lamina - therapist then attempts to side flex the head and axis
Positive sign: if the ligament is intact, there is rotation of the spinous process in the opposite direction of lat flexion - if there is a lag or no concurrent movement, the result is positive and life threatening

Front 8

Alar Ligament Test (Rotational)
Testing For:
Procedure:
Positive Sign:

Back 8

Testing for: reveals rupture of the alar ligament or fracture of the odontoid process of C2
Procedure: client seated - therapist stabilizes the axis with a wide pinch grip around the spinous process of C2 and lamina - therapist then passively rotates the head left or right.
Positive sign: if more than 20 -30 degrees rotation is possible without C2 moving, indicates injury to contraleteral alar ligament especially is lateral flex test is +ve on the same side. If excessive motion in opposite direction for both tests, then instability is due to increase in neutral zone in the joint

Front 9

Spurling`s Test
Testing For:
Procedure:
Positive Sign:

Back 9

Testing for: compression of the cervical nerve root or facet joint irritation in the lower cervical spine
Procedure: client seated - therapist stands behind client - client slowly extends, sidebends and rotates the head to the affected side - therapist applies downward compression on the head of the client
Positive sign: radiating pain or other neurological signs in the same side arm (nerve root) and/or pain local to the neck or shoulder (facet joint irritation) If pain on the other side, then reverse Spurling's sign and indicates muscle spasm

Front 10

Maximum Cervical Compression Test
Testing For:
Procedure:
Positive Sign:

Back 10

Testing for: neurological symptoms /compression of the cervical nerve root or facet joint irritation in the lower cervical spine
Procedure: client seated - therapist behind client - client extends, side flexes and rotates to same side (which maximally closes the vertebral foramina) - therapist applies downward compression on the head of the client - holding for 20-30 seconds can test the vertebral artery
Positive sign: radiating pain into the arm; pain on
the concave side indicates nerve root of facet joint pathology; pain on the convex side indicates muscle strain. If holding, if diziness, nystagmus, faint, nausea then that would indicate compression of vertebral artery

Front 11

Distraction Test
Purpose:
Procedure:
Positive Sign:

Back 11

Purpose: relieve pressure on the cervical nerve root if positive on Spurling or compression test
Procedure: client seated - clients head in neutral position at all times - therapist grasps the clients head at occiput and temporalis - one hand on either side of the head - slowly traction the client's head in a superior direction - maintain the traction for at least 30 sec

Front 12

Shoulder Depression Test
Testing For:
Procedure:
Positive Sign:

Back 12

Testing for: used to evaluate for brachial plexus lesions as the test is the mechanism of injury for these lesions, plexopathies and radiculopathies = with lesions more than one nerve root is affected
Procedures: client seated - therapist side flexes the patient's head to one side while applying downward pressure on the opposite shoulder
Positive sign: if pain is increased, indicates irritation or compression of the nerve root or foraminal encroachments such as osteophytes in the area on the area on the side being compressed or adhesions around the dural sleeves of the nerve and adjacent joint capsule or a hypomobile joint capsule on the side being stretched

Front 13

Jacksons Compression Test
Testing For:
Procedure:
Positive Sign:

Back 13

Testing for: compression of the cervical nerve root or facet joint irritation in the lower cervical spine
Procedure: client seated - therapist bahind client - therapist rotates head to on side - therapist applies downward compression on the head of the client - test is repeated on bother side
Positive sign: radiating pain into the arm, indicating pressure on a nerve root