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

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

3. University of Delaware Vertebral Artery Test n Combined Movements to stress test the cervical spine n Symptoms: –Dizziness -Tinnitus –Lightheadedness –Nystagmus -Parathesia –Dysarthria - Diplopia –Dysphagia

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

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

6. University of Delaware Cervical Distraction n Nerve Root Compression n Radicular pain is decreased, test is positive

7. University of Delaware Cervical Compression Test n Pressure downward on head n Test is positive if pain is evoked

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

9. University of Delaware Spurling B n Seated n Extension n Sidebending and Rotation to the ipsilateral side n 7kg of axial pressure is applied

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

11. University of Delaware Shoulder Abduction Sign n Most common nerve root compression at C5-6 n Decrease in symptoms is positive response

12. University of Delaware Median Nerve Testing n Shoulder Retraction and Depression n Shoulder Extension n External Rotation n Elbow Extension n Forearm Supination n Wrist/Finger Extension n Cervical SB and Rot Away

13. University of Delaware Upper Limb Tension Testing A n Scapular Depression n Shoulder Abduction n Shoulder ER n Elbow Extension n Forearm Sup n Wrist and Finger Extension

14. University of Delaware Radial Nerve Testing n Proximal as for Median n Shoulder Internal Rot n Forearm Pronation n Wrist Flexion n Ulnar Deviation n Finger Flexion

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

16. University of Delaware Ulnar Nerve Testing n Shoulder Retraction n Shld Ext and ER n Elbow Flexion n Forearm Supination n Wrist Extension and Radial Deviation n Finger Extension n Cervical SB and Rot away

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