Special Tests in The Spine Tara Jo Manal PT,OCS, SCS

Cervicothoracic Nerve Root Posterior Head “Shawl” Shoulder and Lateral arm Radial Forearm Thumb/Index Finger Dorsal Forearm Middle/Index Finger Ulnar Forearm 4th and 5th digits Medial Arm C1 Upper Cervical Flexors and Extensors C2 Upper Cervical Rot. C3 Scaleni C4 Diaphragm C5 Biceps (mm and Reflex) Infra/Supraspinatus C6 Brachioradialis (mm and Reflex) Wrist Extensors C7 Triceps Brachii (mm and Reflex) Wrist flexors Finger Extensors Abductor Pollicis brevis C8 Flexor Digitorium Adductor Pollicis Abductor digiti minimi T1 Interossei

Lumbosacral Nerve Root Waist/Backbelt Ventral Thigh to knee Medial lower leg to Malleolus Dorsal Foot Great Toe Lateral Foot and Sole 5th Toe L1-2 Cremaseter (mm and Reflex) L2-3 Hip Adductors L4 Tibialis Anterior Quadriceps (mm and Reflex) L5 Extensor Hallicus Longus Extensor digitorum longus and brevis Tibialis Posterior (mm and reflex) S1 Peroneals Gastroc/soleus (Achilles Tendon Reflex)

Vertebral Artery Test Combined Movements to stress test the cervical spine Symptoms: Dizziness -Tinnitus Lightheadedness Nystagmus -Parathesia Dysarthria - Diplopia Dysphagia

Vertebral Artery Preliminary Test Patient is sitting. Sustain cervical extension for 10 seconds. Sustain Rotation (L and R) 10 seconds IF POSITIVE STOP If the testing is negative progress to standard position.

Vertebral Artery Standard Test Patient is supine. Sustain cervical extension for 10 seconds. Sustain Rotation (L and R) for 10 seconds Combine Extension with Rotation (L and R) for 10 seconds. Test the patient in the manipulation position IF POSITIVE STOP, do not manipulate

Cervical Distraction Nerve Root Compression Radicular pain is decreased, test is positive

Cervical Compression Test Pressure downward on head Test is positive if pain is evoked

Spurling A Seated Neck Side bent to the ipisilateral side 7kg of overpressure applied Presence of pain, parasthesial or numbness

Spurling B Seated Extension Sidebending and Rotation to the ipsilateral side 7kg of axial pressure is applied

Sharp –Purser Test Neck in semi flexion Palm of one hand on forehead Index finger on Spinous process C2 Posterior force through forehead Posterior slide is + for AA instability

Shoulder Abduction Sign Most common nerve root compression at C5-6 Decrease in symptoms is positive response

Median Nerve Testing Shoulder Retraction and Depression Shoulder Extension External Rotation Elbow Extension Forearm Supination Wrist/Finger Extension Cervical SB and Rot Away

Upper Limb Tension Testing A Scapular Depression Shoulder Abduction Shoulder ER Elbow Extension Forearm Sup Wrist and Finger Extension

Radial Nerve Testing Proximal as for Median Shoulder Internal Rot Forearm Pronation Wrist Flexion Ulnar Deviation Finger Flexion

Upper Limb Tension Testing B Supine in 30º Abd Scap Depression Shoulder IR Elbow Extension Wrist and Finger Flexion Opposite Cervical SB and Rot

Ulnar Nerve Testing Shoulder Retraction Shld Ext and ER Elbow Flexion Forearm Supination Wrist Extension and Radial Deviation Finger Extension Cervical SB and Rot away

T1 Nerve Root Stretch Abduct to 90º Flex pronated arms to 90º Flex elbows and place behind the neck Pain in scapular area is T1- Pain in Ulnar distribution is Ulnar

Bowstring Test Cram Test/ Popliteal Pressure Sign SLR by Examiner Knee is Flexed to Reduce Symptoms Pressure to popliteal fossa to bring symptoms back

L’hermitte’s Sign Dural Irritation Long Sitting Examiner flexes head and hips Sharp pain down spine and into upper or lower extremities is Positive

Hoover’s Sign Examiner places a hand under each heel Ask patient to perform SLR If unable to lift leg but no downward pressure on opposite limb ?

Kernig’s Sign Meningeal/Dural/Root Involvement Supine with head in hands Flex head to chest Raise lower leg in extension

Straight Leg Raise Raise leg while watching patient Look for reproduction of symptoms Lower the angle, more irritated or compressed is the nerve

SLR Modifications Cervical Flexion Ankle dorsiflexion Hip Internal Rotation Leg Abduction Traction imposed irritates dura relieves stenosis

Crossed SLR SLR of asymptomatic leg creates symptoms in involved leg Indicative of a greater problem

Bilateral SLR Central Disc protrusion Stenosis Rule out with stenosis tests

Slump Test Start Position Provocative Test Once symptoms are reproduced test is terminated

Slump Test Middle Position Thoracic and Lumbar Slump

Slump Test Final Position Can add leg Adduction

Nerve Flossing

Reverse Lasegue Test Prone Knee Flexion L2, L3 or L4 Sidelying or Prone Knee Flexion avoiding back extension Pain is reproduced down the Anterior Thigh Can add hip ext

Beevor’s Sign Supine Raise head or cough Umbilicus should remain in straight line 10th-12th nerve palsy Abdominal Cutaneous Reflex

Prone Instability Test Prone with legs off bed PA spring for pain Patient lifts legs off the bed Re-do spring testing If pain subsides on re-test is Positive