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Special Tests in The Spine

Special Tests in The Spine. Tara Jo Manal PT,OCS, SCS. Vertebral Artery Test. Combined Movements to stress test the cervical spine Symptoms: Dizziness -Tinnitus Lightheadedness Nystagmus -Parathesia Dysarthria - Diplopia Dysphagia. Vertebral Artery Preliminary Test.

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Special Tests in The Spine

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  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

  18. Intervention • 3 Thrust Manipulations • 2 reps of each • Seated Distraction

  19. Intervention • Supine Upper Thoracic Manip

  20. Intervention • Supine Middle Thoracic Manipulation

  21. Other Intervention • Cervical ROM

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

  23. 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

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