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

2. 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

3. 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)

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

5. 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.

6. 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

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

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

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

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

11. 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

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

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

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

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

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

17. 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

18. 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

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

20. 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

21. 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 ?

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

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

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

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

26. Bilateral SLR Central Disc protrusion Stenosis
Rule out with stenosis tests

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

28. Slump Test
Middle Position
Thoracic and Lumbar Slump

29. Slump Test
Final Position
Can add leg Adduction

30. Nerve Flossing

31. 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

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

33. 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