1. Cervical and Thoracic spine

4. Upper limb tension test 1
Tension on C5, C6, C7 nerve root
Median nerve dominant
Not specific with regard to a given level
Median N. 관련된 1 – 3 root의 자극, 압박

5. Shoulder abduction
Arm on examiner’s Rt thigh
examiner’s Rt hand on shoulder
Examiner’s Lt hand grasp Rt hand

6. Shoulder abduction at 110 degree

7. Supinate forearm
Extend wrist, fingers

8. Shoulder external rotation 90 degree

9. Elbow is extended slowly

10. If nerve root tension present~
Bending neck to be tested, Sx release

11. Stretching, aching at Antecubital fossa
: WNL
C5 : lateral detoid and the midarm
C6 : dorsal radial aspect of the forearm
involving index finger and the thumb
C7 : centrally down the forearm
involving the long finger

12. Upper limb tension test 2
C6, C7 nerve root
Median nerve dominant
Radial nerve dominant

13. 1) Median nerve dominant
Examiner’s left thigh depress pt’s shoulder
Shoulder 10 abduction

14. 1) Median nerve dominant
Extend elbow
External rotation upper limb

15. 1) Median nerve dominant
Extend the MCP joint
Dorsiflextion the wrist
Abducting shoulder to 90
If radicular pain develop, positve finding

16. 2) Radial nerve dominant
Elbow extension
Internal rotation
Flex the wrist, thumb, fingers

17. Upper limb tension test 3
C8, T1 nerve root
Ulnar nerve dominant

18. Flexed elbow
Wrist dorsifexion, forearm supination

19. Elbow is maximally flexed
Examiner’s hand depress the shoulder

20. Shoulder external rotation, abduction
Approximating the hand to his own ear
Bend neck away from tested side

21. Tugging sensation in the axilla : WNL
C8 : radiating down the arm past the
elbow to the little finger
T1 : radiating down the arm past the
elbow to the axilla

22. Axial compression test
CIx: Motor deficit is suspected
Force should be gentle and gradual
Neck, shoulder, upper extremities pain

23. Distraction test

24. Spurling’s test Neck is extended, rotated toward the
Involved side prior to axial compression
Decreasing the dimensions of the nerve
Root foramen

25. Response to Axial compression test and Spurling’s test
No discomfort
Sensation of heaviness
Nonradicular pain
Pseudoradicular pain
Radicular pain

26. No discomfort muscular strains mild ligamentous sprains
-> pain is not aggravated by test

27. Nonradicular pain, Pseudoradicular pain
radiates to the occiput, scapular, sholders occasionally down the arm
but not distal to the elbow
1. Spondylolisthesis
2. Degenerative disc disease
without nerve root compression

28. Radicular pain Radiates into upper extremity Usually below the elbow
Along the distribution of dermatome
Young adults: intervertebral disc prolapse
Older patient: foraminal stenosis owing to
the combination of disc degeneration and
secondary facet hypertrophy

29. LHERMITTE’S Maneuver Flex the cervical and the thoracic spine
Distal paresthesias in the extremities or the trunk
Indicative of spinal stenosis

30. Nonorganic signs of Waddell
Cannot be explained by current knowledge of anatomy & physiology
Behavioral maladaptations to disease process or reaction to Real or perceived pain

31. 1. Nonanatomic tenderness
by light touch or TD
R/O reflex sympathetic dystrophy

32. 2. Simulation sign : low back, entire spine pain Exaggerated response
to axial compression test
: low back, entire spine pain
Rotation simulation maneuver:
no torsional force on spine because coplanar with pelvis -> but pain agg.

33. 3. Distraction Sign radicular pain nonorganic Supine + Seated position-

34. 4. Regional sensory or motor disturbance
: Stocking, glove distribution
Ex) DM neuropathy
2. Motor
: diffuse motor weakness of multiple
muscle group

35. 5. Overreaction
light forms of palpation or gentle examination techniques
-> reacts physically or verbally in an inappropriately
theatrical manner

36. 다음중 organic pain일 가능성이 높은 상황을 고르세요