University of Delaware

Special Tests in The SpineSpecial Tests in The Spine

Tara Jo Manal PT,OCS, SCSTara Jo Manal PT,OCS, SCS

University of Delaware

Vertebral Artery TestVertebral Artery Test Combined Movements Combined Movements

to stress test the to stress test the cervical spinecervical spine

Symptoms: Symptoms: – Dizziness -TinnitusDizziness -Tinnitus

– LightheadednessLightheadedness

– Nystagmus -ParathesiaNystagmus -Parathesia

– Dysarthria - DiplopiaDysarthria - Diplopia

– DysphagiaDysphagia

University of Delaware

Vertebral Artery Preliminary Vertebral Artery Preliminary TestTest

Patient is sitting. Sustain cervical extension Patient is sitting. Sustain cervical extension for 10 seconds.for 10 seconds.

Sustain Rotation (L and R) 10 secondsSustain Rotation (L and R) 10 seconds IF POSITIVE STOPIF POSITIVE STOP If the testing is negative progress to If the testing is negative progress to

standard position.standard position.

University of Delaware

Vertebral Artery Standard TestVertebral Artery Standard Test

Patient is supine. Sustain cervical extension Patient is supine. Sustain cervical extension for 10 seconds. for 10 seconds.

Sustain Rotation (L and R) for 10 secondsSustain Rotation (L and R) for 10 seconds Combine Extension with Rotation (L and R) Combine Extension with Rotation (L and R)

for 10 seconds.for 10 seconds. Test the patient in the Test the patient in the manipulationmanipulation

positionposition IF POSITIVE IF POSITIVE STOPSTOP, do not manipulate, do not manipulate

University of Delaware

Cervical DistractionCervical Distraction

Nerve Root Nerve Root CompressionCompression

Radicular pain is Radicular pain is decreased, test is decreased, test is positivepositive

University of Delaware

Cervical Compression TestCervical Compression Test

Pressure downward on Pressure downward on headhead

Test is positive if pain Test is positive if pain is evokedis evoked

University of Delaware

Spurling ASpurling A

SeatedSeated Neck Side bent to the Neck Side bent to the

ipisilateral sideipisilateral side 7kg of overpressure 7kg of overpressure

appliedapplied

Presence of pain, Presence of pain, parasthesial or parasthesial or numbnessnumbness

University of Delaware

Spurling BSpurling B

SeatedSeated ExtensionExtension Sidebending and Sidebending and

Rotation to the Rotation to the ipsilateral sideipsilateral side

7kg of axial pressure 7kg of axial pressure is appliedis applied

University of Delaware

Sharp –Purser TestSharp –Purser Test

Neck in semi flexionNeck in semi flexion Palm of one hand on Palm of one hand on

foreheadforehead Index finger on Index finger on

Spinous process C2Spinous process C2 Posterior force Posterior force

through foreheadthrough forehead Posterior slide is + for Posterior slide is + for

AA instabilityAA instability

University of Delaware

Shoulder Abduction SignShoulder Abduction Sign

Most common nerve Most common nerve root compression at root compression at C5-6C5-6

Decrease in symptoms Decrease in symptoms is positive responseis positive response

University of Delaware

Median Nerve TestingMedian Nerve Testing

Shoulder Retraction Shoulder Retraction and Depressionand Depression

Shoulder ExtensionShoulder Extension External RotationExternal Rotation Elbow ExtensionElbow Extension Forearm SupinationForearm Supination Wrist/Finger Wrist/Finger

ExtensionExtension Cervical SB and Rot Cervical SB and Rot

AwayAway

University of Delaware

Upper Limb Tension Testing AUpper Limb Tension Testing A

Scapular DepressionScapular Depression Shoulder AbductionShoulder Abduction Shoulder ERShoulder ER Elbow ExtensionElbow Extension Forearm SupForearm Sup Wrist and Finger Wrist and Finger

ExtensionExtension

University of Delaware

Radial Nerve TestingRadial Nerve Testing

Proximal as for Proximal as for MedianMedian

Shoulder Internal RotShoulder Internal Rot Forearm PronationForearm Pronation Wrist FlexionWrist Flexion Ulnar DeviationUlnar Deviation Finger FlexionFinger Flexion

University of Delaware

Upper Limb Tension Testing BUpper Limb Tension Testing B

Supine in 30Supine in 30º Abdº Abd Scap DepressionScap Depression Shoulder IRShoulder IR Elbow ExtensionElbow Extension Wrist and Finger Wrist and Finger

FlexionFlexion Opposite Cervical SB Opposite Cervical SB

and Rotand Rot

University of Delaware

Ulnar Nerve TestingUlnar Nerve Testing

Shoulder RetractionShoulder Retraction Shld Ext and ERShld Ext and ER Elbow FlexionElbow Flexion Forearm SupinationForearm Supination Wrist Extension and Wrist Extension and

Radial DeviationRadial Deviation Finger ExtensionFinger Extension Cervical SB and Rot Cervical SB and Rot

awayaway

University of Delaware

T1 Nerve Root StretchT1 Nerve Root Stretch

Abduct to 90Abduct to 90ºº Flex pronated arms to Flex pronated arms to

9090º º Flex elbows and place Flex elbows and place

behind the neckbehind the neck Pain in scapular area is Pain in scapular area is

T1- Pain in Ulnar T1- Pain in Ulnar distribution is Ulnardistribution is Ulnar

University of Delaware

Cervical Lateral GlidesCervical Lateral Glides

University of Delaware

University of Delaware

University of Delaware

InterventionIntervention

3 Thrust 3 Thrust ManipulationsManipulations– 2 reps of each2 reps of each

Seated DistractionSeated Distraction

University of Delaware

InterventionIntervention

Supine Upper Supine Upper Thoracic ManipThoracic Manip

University of Delaware

InterventionIntervention

Supine Middle Supine Middle Thoracic ManipulationThoracic Manipulation

University of Delaware

Other InterventionOther Intervention

Cervical ROMCervical ROM

University of Delaware

Upper Thoracic ManipulationUpper Thoracic Manipulation

CT junctionCT junction Patient sits far back on Patient sits far back on

tabletable Stabilize shoulders Stabilize shoulders Use their hands as Use their hands as

fulcrumfulcrum Distract upwardsDistract upwards

– Drop downDrop down

University of Delaware

Winters, et al., 1997Winters, et al., 1997

Manipulation to Manipulation to surrounding structures in surrounding structures in patients with complaints patients with complaints originating from the originating from the shoulder girdle are more shoulder girdle are more effective when the effective when the shoulder pain is not shoulder pain is not related to decreased ROM related to decreased ROM in the glenohumeral jointin the glenohumeral joint