Cervical Spine Orthopedic Tests
Cervical Spine Orthopedic Tests:
Cervical Spine Exams:
- Anterior Neck Flexors Strength Test
- Anterolateral Neck Flexors Strength Test
- Cervical Compression Test
- Cervical Distraction
- First Rib Mobility Test
- Posterolateral Neck Flexors Strength Test
- Spurling’s Test
- Swallowing Test
- Three- Knuckle Test
- Upper Trapezius Strength Test
- Vertebral Artery Test
Cervical Spine Orthopedic/ Special Test: Anterior Neck Flexors Strength Test
Purpose:
To asses the strength of the neck flexors ( SCM, anterior scalene, supra and infrahyoids, longus colli and capitis, and rectus capitis anterior)
Procedure:
– Client is supine
– Client abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
– Client tucks chin, and then lifts head off the table.
– Client keeps the head lifted off the table ( Grade 3). Client resists therapist posteriorly-directed pressure ( Grade 5)
Positive Sign:
Weakness of Anterior Neck Flexors if Client is unable to keep the neck in flexion against gravity or the therapist’s pressure.
Cervical Spine Orthopedic/ Special Test: Anterolateral Neck Flexors Strength Test
Purpose:
To asses the strength of the Anterolateral Neck Flexors ( SCM and scalene on one side).
Procedure:
– Client is supine
– Client abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
– Client rotates the head away from the side being tested. Therapist stabilizes the side being tested.
– Client lifts the head into slight flexion and hold it against gravity.
– Client keeps the head lifted off the table (Grade 3).
– Therapist holds the temporal region on the side being tested.
– Therapist pushes in an oblique posterolateral direction, away from the tested side.
Positive Sign:
weakness of the Anterolateral Neck Flexors if the client is unable to keep the neck in flexion against gravity or the therapist’s pressure.
Cervical Spine Orthopedic/ Special Test: Cervical Compression Test ( for clients who cannot rotate or extend their head)
Testing For:
Compression of cervical nerve root or facet joint irritation in the Lower Cervical Spine
Procedure:
– Client is seated. Client’s head is in neutral. Therapist stands behind client.
– Carefully apply compression downward on the head of the client.
Positive Sign:
Radiating pain or other neurological signs in the same side arm ( nerve root) and/ or pain local to the neck or shoulder ( facet joint irritation).
Cervical Spine Orthopedic Test: Cervical Distraction
Purpose:
To relieve the pressure on the cervical nerve roots ( may be used after Spurling’s or Cervical Compression Tests)
Procedure:
– Client is supine or seated. Client’s head is in a neutral position at all times throughout the procedure.
– Therapist grasps the client’s head at occiput and temporalis. One hand on either side of the head.
– Slowly traction the client’s head in a superior direction. Maintain the traction for at least 30 seconds.
Cervical Spine Orthopedic Test: First Rib Mobility Test
Purpose:
To test the mobility of Rib 1
Procedure:
– Client is seated.
– Client fully rotates their head away from the side being tested.
– Client then fully flexes the head to their chest.
Positive Sign:
Client has limited neck flexion. The cause for the hypomobilty may be tight scalenes.
Cervical Spine Orthopedic Test: Posterolateral Neck Flexors Strength Test
Purpose:
To asses the strength of the Posterolateral Neck Flexors ( splenius capitis and cervicis, semispinalis capitis and cervicis, cervical Erector Spinae on one side)
Procedure:
– Client is supine
– Client abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
– Client extends their neck. Therapist stabilizes the side being tested.
– Client then rotates the head towards the side being tested.
– Client holds the head in this position.
– Client keeps the position against gravity (Grade 3).
– Therapist holds temporalis area of the unaffected side, then pushes in an oblique posterolateral direction, away from the tested side.
Positive Sign:
weakness of the Posterolateral Neck Flexors if the client is unable to hold their neck against gravity or the therapist’s pressure.
Cervical Spine Orthopedic Test: Spurling’s Test
Testing For:
Compression of a cervical nerve root or facet joint irritation in the Lower Cervical Spine
Procedure:
– Client is seated. Therapist stands behind client.
– Client slowly extends, sidebends, and rotates the head to the affected side.
– Therapist carefully apply compression downward on the head of client.
Positive Sign:
Radiating pain or other neurological signs in the same side arm ( nerve root) and/ or pain local to the neck or shoulder ( facet joint irritation).
Cervical Spine Orthopedic Test: Swallowing Test
Purpose:
To see if the cause of the pain when swallowing, is trigger points on the SCM
Procedure:
– Client is seated
– Palpate and Pincer grasp SCM. Locate the most tender point. Place a firm pressure on the most tender point ( muscle belly) and have the client swallow
Positive Sign:
pain diminishes when the client swallows as you pincer grasp the most tender point
Otherwise:
pain may be caused by throat infection, hematoma, bony protruberance of the cervical spine or tumor so client should be advised to see a medical doctor.
Orthopedic / Special Test: Three- Knuckle Test
Testing For:
The available active range of depression of the mandible or TMJ hypomobility
Procedure:
– Tell client to open jaw
– Ask them to insert as many of their own flexed proximal interphalangeal joints of the non-dominant hand
Positive Sign:
Client can only get one knuckle or knuckles between their teeth.
Cervical Spine Orthopedic Test: Upper Trapezius Strength Test
Purpose:
To asses the strength of the Upper Trapezius Muscle
Procedure:
– Client is supine
– Client abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
– Client extends their neck. Therapist stabilizes the side being tested.
– Client then rotates the head away the side being tested.
– Client holds the head in this position.
– Client keeps the position against gravity (Grade 3).
– Therapist apply pressure on the posterior head, slightly pushing the head anteriorly and obliquely away from the tested side.
– Client tries to resist therapist’s pressure ( Grade 5)
Positive Sign:
Weakness of the Upper Trapezius if the client is unable to hold their neck against gravity or the therapist’s pressure.
Cervical Spine Orthopedic Test : Vertebral Artery
Testing For:
Ischemia or Circulation deficiency of the vertebral artery at the transverse foramen
Procedure:
– Client seated
– Client actively rotates the head fully to one side, then extends the neck
– Hold for 30 seconds
– Do the same on the other side
Positive sign:
Client complains of dizziness, nystagmus, or both. ( Further testing is contraindicated and client must be referred to a doctor )