Special Tests in The Spine

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

2. C1 Upper Cervical Flexors and Extensors C2 Upper Cervical Rot. C3 Scaleni C4 Diaphragm C5 Biceps (mm and Reflex) Infra/Supraspinatus C6 Brachioradialis (mm and Reflex) Wrist Extensors C7 Triceps Brachii (mm and Reflex) Wrist flexors Finger Extensors Abductor Pollicis brevis C8 Flexor Digitorium Adductor Pollicis Abductor digiti minimi T1Interossei Posterior Head “Shawl” Shoulder and Lateral arm Radial Forearm Thumb/Index Finger Dorsal Forearm Middle/Index Finger Ulnar Forearm 4th and 5th digits Medial Arm Cervicothoracic Nerve Root

3. L1-2 Cremaseter (mm and Reflex) L2-3 Hip Adductors L4 Tibialis Anterior Quadriceps (mm and Reflex) L5 Extensor Hallicus Longus Extensor digitorum longus and brevis Tibialis Posterior (mm and reflex) S1 Peroneals Gastroc/soleus (Achilles Tendon Reflex) Waist/Backbelt Ventral Thigh to knee Medial lower leg to Malleolus Dorsal Foot Great Toe Lateral Foot and Sole 5th Toe Lumbosacral Nerve Root

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

5. 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.

6. 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

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

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

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

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

11. 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

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

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

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

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

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

17. 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

18. 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

19. Bowstring Test • Cram Test/ Popliteal Pressure Sign • SLR by Examiner • Knee is Flexed to Reduce Symptoms • Pressure to popliteal fossa to bring symptoms back

20. L’hermitte’s Sign • Dural Irritation • Long Sitting • Examiner flexes head and hips • Sharp pain down spine and into upper or lower extremities is Positive

21. Hoover’s Sign • Examiner places a hand under each heel • Ask patient to perform SLR • If unable to lift leg but no downward pressure on opposite limb • ?

22. Kernig’s Sign • Meningeal/Dural/Root Involvement • Supine with head in hands • Flex head to chest • Raise lower leg in extension

23. Straight Leg Raise • Raise leg while watching patient • Look for reproduction of symptoms • Lower the angle, more irritated or compressed is the nerve

24. SLR Modifications • Cervical Flexion • Ankle dorsiflexion • Hip Internal Rotation • Leg Abduction • Traction imposed irritates dura relieves stenosis

25. Crossed SLR • SLR of asymptomatic leg creates symptoms in involved leg • Indicative of a greater problem

26. Bilateral SLR • Central Disc protrusion • Stenosis • Rule out with stenosis tests

27. Slump Test • Start Position • Provocative Test • Once symptoms are reproduced test is terminated

28. Slump Test • Middle Position • Thoracic and Lumbar Slump

29. Slump Test • Final Position • Can add leg Adduction

30. Nerve Flossing

31. Reverse Lasegue Test • Prone Knee Flexion • L2, L3 or L4 • Sidelying or Prone • Knee Flexion avoiding back extension • Pain is reproduced down the Anterior Thigh • Can add hip ext

32. Beevor’s Sign • Supine • Raise head or cough • Umbilicus should remain in straight line • 10th-12th nerve palsy • Abdominal Cutaneous Reflex

33. Prone Instability Test • Prone with legs off bed • PA spring for pain • Patient lifts legs off the bed • Re-do spring testing • If pain subsides on re-test is Positive