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

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

3. 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.

4. 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

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

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

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

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

9. 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

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

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

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

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

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

15. 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

16. 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

17. Cervical Lateral Glides

20. Intervention
3 Thrust Manipulations
2 reps of each
Seated Distraction

21. Intervention
Supine Upper Thoracic Manip

22. Intervention
Supine Middle Thoracic Manipulation

23. Other Intervention
Cervical ROM

24. Upper Thoracic Manipulation
CT junction
Patient sits far back on table
Stabilize shoulders
Use their hands as fulcrum
Distract upwards
Drop down

25. Winters, et al., 1997
Manipulation to surrounding structures in patients with complaints originating from the shoulder girdle are more effective when the shoulder pain is not related to decreased ROM in the glenohumeral joint
In a study by Winters et. al. The authors demonstrated a favorable response from manipulation to the surrounding structures of the shoulder when shoulder symptoms were not related to ROM deficits in the glenohumeral joint.
And you can see a standard technique of thoracic manipulation utilized by many therapists.