Transcript Cervical Orthopedic Tests

Cervical Orthopedic Tests
Chapters 3 & 4
Tenderness Grading Scale
Grade I – mild tenderness to palpation
Grade II – mild tenderness with grimace
and flinch to moderate palpation
Grade III – severe tenderness with
withdrawal
Grade IV – severe tenderness with
withdrawal from noxious stimuli
Cervical Palpation (Anterior)
Sternocleidomastoid
Carotid arteries
Supraclavicular Fossa
Cervical Palpation (Posterior)
Trapezius
Cervical intrinsic musculature
Spinous processes / facet joints
Cervical Range of Motion
Take a thorough history to be certain that
these motions will not adversely affect the
patient.
Trauma causing fracture, dislocation, or
vascular compromise would be
contraindications to performing these tests.
Note limited range of motion.
Note pain location and character.
Normal Cervical ROM
Flexion – 50 degrees or more
Extension – 60 degrees or more
Lateral flexion – 45 degrees or more
Rotation – 80 degrees or more
Cervical Resistive Isometric
Testing
Evaluate muscle strength and state.
Weakness may indicate neurological
dysfunction.
Pain indicates muscle dysfunction such as a
strain.
Muscle Grading Scale
5 – Complete range of motion against gravity with
full resistance.
4 – Complete range of motion against gravity with
some resistance.
3 – Complete range of motion against gravity.
2 – Complete range of motion with gravity
eliminated.
1 – Evidence of slight contractility.
0 – no evidence of contractility.
Vertebrobasilar Circulation
Assessment
Vascular Insufficiency may be aggravated
by positional change in the cervical spine.
Assessment of the vertebrobasilar
circulation must be done if cervical
adjustment or manipulation is to be
performed.
Predispositions to
Cerebrovascular Accidents
Headaches, migraine
Dizziness
Sudden severe head or neck pain
Hypertensive
Predispositions to
Cerebrovascular Accidents
Cigarette smoking
Oral Contraceptives
Obesity
Diabetes
Cerebrobasilar Testing
Positional change in the cervical spine
compresses the vertebral artery at the
atlantoaxial junction on the side opposite of
rotation.
In the normal patient, the diminished blood
flow does not cause any neurological
symptoms, such as dizziness, nausea,
tinnitus, faintness, or nystagmus.
Clinical Signs and Symptoms of
Cerebrovasular Episodes
Vertigo, dizziness, giddiness, lightheadedness
Drop attacks, loss of consciousness
Diplopia
Dysarthria
Clinical Signs and Symptoms of
Cerebrovasular Episodes
Dysphagia
Ataxia of gait
Nausea, vomiting
Numbness on one side of the face
Nystagmus
Barre-Lieou Sign
Procedure: Patient rotates head from one
side to the other.
Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, nystagmus.
Structure affected: Vertebral artery on the
same side of head rotation. Consider
patency of the carotid arteries and the
communicating cerebral artery circle.
Barre-Lieou Sign
Vertebrobasilar Artery
Functional Maneuver
Procedure: Palpate and auscultate the
carotid arteries for pulsations and bruits.
Instruct the patient to rotate and
hyperextend the head.
Vertebrobasilar Artery
Functional Maneuver
Positive Test: If pulsation or bruits are
present at either the carotid or subclavian
arteries the test is positive.
Structures Affected: It may indicate
stenosis or compression of the carotid or
subclavian arteries.
Vertebrobasilar Artery
Functional Maneuver
Maigne’s Test
Procedure: Patient extends and rotates the
head and holds that position for 15 – 40
seconds. Repeat on opposite side.
Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
Maigne’s Test
Dekleyn’s Test
Procedure: Patient supine, head off table.
Instruct pt. to hyperextend and rotate head.
Hold 15 to 30 seconds. Repeat opposite.
Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
Dekleyn’s Test
Hautant’s Test
Procedure: Pt. Seated, eyes closed, extend
arms to front with palms up. Pt. extend and
rotate head.
Positive Test: Patient loses balance, drops
arms, and will pronate the hands.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
Hautant’s Test
Underburg’s Test
Procedure: Pt. standing. Close eyes and
assess equilibrium. Stretch arms and
supinate hands. Then pt. marches in place.
Then pt. extends and rotates head while
marching. Then opposite side.
Underburg’s Test
Positive Test: Patient loses balance, arms
drift, hands pronate. Vertigo, dizziness,
visual blurring, nausea, faintness, and
nystagmus.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
Underburg’s Test
Hallpike’s Maneuver
Procedure: Pt. supine with head extended
off table. Support head and move it into
extension. Then laterally flex and rotate.
Hold 15 to 40 seconds. Repeat opposite.
Then hang head in free hyperextension.
Hallpike’s Maneuver
Positive Test: Vertigo, dizziness, visual
blurring, nausea, faintness, and nystagmus.
Structures Affected: Vertebral, basilar, or
carotid artery stenosis or compression.
Hallpike’s Maneuver
Hallpike’s Maneuver
Clinical Signs and Symptoms of
Cervical Strain or Sprain
Cervical and upper back pain
Cervical and upper back stiffness
Cervical and upper trapezius tightness
Reduced cervical range of motion
Cervical extensor spasm
Differentiating Between Strain
and Sprain
Cervical strain is an irritation and spasm of
the muscles of the cervical spine with or
without partial muscle fiber tearing.
Cervical sprain is a wrenching of the joints
of the cervical spine with partial tearing of
its ligaments.
Categories of Strain
Mild: Slight disruption of muscle fibers
with no appreciable hemorrhage and
minimal amounts of swelling and edema.
Categories of Strain
Moderate: Laceration of muscle fibers with
an appreciable amount of hemorrhage into
the surrounding tissues and a moderate
amount of swelling and edema.
Severe: Complete disruption of the muscle
tendon unit, possibly with tearing of the
tendon from the bone or a rupture of the
muscle through its belly.
Categories of Sprain
Mild: Slight tears of a few ligamentous
fibers.
Moderate: More sever tearing of
ligamentous fibers but not complete
separation of the ligament.
Categories of Sprain
Severe: Complete tearing of a ligament
from its attachments.
Avulsion: A ligament that attaches to a
bone is pulled loose with a fragment of that
bone.
O’Donoghue’s Maneuver
Procedure: Patient seated. Put the cervical
spine through resisted range of motion, then
through passive range of motion.
Positive Test: Pain during resisted range of
motion or isometric muscle contraction
signifies muscle strain. Pain during passive
range of motion may indicate a sprain of
any of the cervical ligaments.
O’Donoghue’s Maneuver
Structures Affected: Cervical spinal
muscles and/or cervical spinal ligaments.
Since resisted range of motion mainly
stresses muscles and passive range of
motion mainly stresses ligaments, you
should be able to determine between strain
and sprain or a combination thereof.
O’Donoghue’s Maneuver
Spinal Percussion Test
Procedure: Patient seated. Head slightly
flexed, percuss the spinous process and
associated musculature of each cervical
vertebrae with a reflex hammer.
Spinal Percussion Test
Positive Test: Local pain may be a
fractured vertebra with no neurological
compromise. Radicular pain may be a
fractured vertebra with neurological
compromise or a disc lesion with
neurological compromise. A ligamentous
sprain could also elicit pain upon percussion
of the spinous processes.
Spinal Percussion Test
Soto-Hall Test
Procedure: Patient Supine. Press on the
patient’s sternum with one hand. With the
other hand, passively flex the patient’s head
to the chest.
Positive Test: Local pain could indicate
ligament, muscular, ossous pathology or
cervical cord disease. Suspect disc defect
with radicular symptoms.
Soto-Hall Test
Rust’s Sign
Procedure: A patient with severe injury to
the upper cervical spine will grasp the head
with both hands to support the weight of the
head on the cervical spine. The supine
patient will support the head while
attempting to rise.
Positive Sign: The patient stabilizes the
head. It might include slight traction.
Rust’s Sign
Structures Affected: This could represent
severe muscular strain, ligamentous
instability, posterior disc defect, upper
cervical fracture, or dislocation.
Rust’s Sign
Cervical Instability Clinical
Signs and Symptoms
Severe cervical pain.
Patient stabilizing the head.
Little or no cervical motion.
Severe cervical muscle spasm.
Upper extremity neurological dysfunction.
Lower extremity neurological dysfunction.
Space-Occupying Lesions
Clinical Signs and Symptoms
Cervical pain.
 Upper extremity neurological symptoms.
 Lower extremity neurological symptoms.

Valsalva’s Maneuver
Procedure: Have the patient bear down as if
defecating and focus the bulk of the stress
on the cervical spine. Ask if the patient
feels pain and have them point to the
location.
Valsalva’s Maneuver
Positive Test: Local pain with increased
pressure could indicate a space-occupying
lesion (e.g. disc defect, mass, osteophyte) in
the cervical canal or foramen.
Valsalva’s Maneuver
Dejerine’s Sign
Procedure: Patient seated. Instruct them to
cough, sneeze, and bear down as if
defecating (Valsalva’s maneuver).
Positive Test: Local pain or pain radiating
to the shoulders or upper extremities
indicates an increase in intrathecal pressure.
Structures Affected: Space-occupying
lesion.
Cervical Neurological
Compression and Irritation
Clinical Signs and Symptoms
Cervical pain.
 Upper extremity radicular pain.
 Loss of upper extremity sensation.
 Loss of upper extremity reflexes.
 Loss of upper extremity muscle strength.

Foraminal Compression Test
Procedure: Patient seated. Exert strong
downward pressure on the head. Repeat
with b/l rotation.
Positive Test: Local pain may indicate
foraminal encroachment without nerve root
pressure or apophyseal capsulitis.
Radicular pain may indicate pressure on a
nerve root.
Foraminal Compression Test
Jackson’s Compression
Procedure: Laterally flex the head and exert
strong downward pressure. Perform b/l.
Positive Test: Local pain may indicate
foraminal encroachment without nerve
pressure or apophyseal joint pathology.
Radicular pain may indicate pressure on a
nerve root.
Jackson’s Compression
Spurling’s Test
Procedure: Laterally flex the patient’s head
and gradually apply strong downward
pressure. If no pain is elicited, put the
patient’s head in a neutral position and
deliver a vertical blow to the uppermost
portion of the patient’s head.
Spurling’s Test
Positive Test: Local pain indicates facet
joint involvement. Radicular pain indicates
nerve root pressure.
Spurling’s Test
Maximum Foraminal
Compression Test
Procedure: Have the patient approximate
the chin to the shoulder and extend the
head. Perform b/l.
Maximum Foraminal
Compression Test
Positive Test: Pain on the side of rotation
with a radicular component may indicate
nerve compression. Local pain with no
radiculopathy may indicate apophyseal joint
pathology on the side of rotation. Pain
opposite of rotation indicates muscular or
ligamentous strain.
Maximum Foraminal
Compression Test
Shoulder Depression Test
Procedure: Apply downward pressure on
the shoulder while laterally flexing the
patient’s head to the opposite side.
Shoulder Depression Test
Positive Test: Local pain on the side being
tested indicates shortening of the muscles,
muscular adhesions, muscle spasm, or
ligamentous injury. Radicular pain may
indicate compression of the neurovascular
bundle or thoracic outlet syndrome. Pain on
the opposite side indicates a decreased
foraminal space, facet pathology, or disc
defect.
Shoulder Depression Test
Distraction Test
Procedure: Grasp beneath the mastoid
processes and press up on the patient’s
head. This removes the weight of the
patient’s head on the neck.
Distraction Test
Positive Test: If local pain increases,
suspect muscle strain, spasm, ligamentous
sprain, or facet capsulitis. Relief of
radicular pain indicates either foraminal
encroachment or a disc defect.
Distraction Test
Shoulder Abduction Test
(Bakody’s Sign)
Procedure: The patient should abduct the
arm and place the hand on top of the head.
Positive Test: A decrease or relief of the
patient’s symptoms indicates a cervical
extradural compression problem (i.e.
herniated disc, epidural vein compression,
or nerve root compression).
Shoulder Abduction Test
(Bakody’s Sign)