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    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test

Cervical Spine

Range of Motion

Picture
ROM Using a Goniometer (Cleland et al, 2008):
Flexion: 40 degrees
Extension: 50 degrees
Rotation: ~50 degrees
Lateral Flexion: 22 degrees

Cervical Clearing Test:
AROM with overpressure in all directions

Manual Muscle Tests

Coming soon...

​Special Tests

Alar Ligament Test
Bakody's Sign
Cervical Distraction Test
Cervical Rotation Lateral Flexion Test
Craniocervical Flexion Test
Deep Neck Flexor Endurance Test
Posterior-Anterior Segmental Mobility
Segmental Mobility
Sharp-Purser Test
Spurling's Maneuver
Transverse Ligament Test
ULNT - Median
ULNT - Radial
ULNT - Ulnar
Vertebral Artery Test
Picture
Picture

Cervical Research

Canadian C-Spine Rules:
1. 65+ or dangerous mechanism* or paresthesias in extremities (if yes, radiographs indicated)
2. Any low risk factor that allows safe assessment of AROM (if no, radiographs indicated)
3. Active 45 deg of rotation bilaterally in neck (if no, radiographs indicated)

*Dangerous Mechanism: fall from elevation > 3ft, axial load to head, MVC high speed/rollover/ejection, motorized recreational vehicles, bicycle collision

**Low Risk Factor: simple rearend MVC (EXCLUDES: pushed into oncoming traffic/hit by bus/rollover/hit by high speed vehicle), sitting position in ED, ambulatory at any time, delayed onset of neck pain, absence of midline c-spine tenderness


Cervical Manipulation for Neck Pain (Puentedura et al, 2012):
-Symptom duration of < 38 days
-Positive expectation that manipulation will help
-Side to side difference in cervical rotation ROM of 10 deg or greater
-PAin with PA spring testing of the middle cervical spine

3 positive: Sn .81, Sp .94, +LR 13.5
4 positive: Sn .5, Sp 1.0, +LR infinite


Cervical Myelopathy (Cook et al, 2010):
-Ataxic gait
(+) Hoffman's Test
(+) Babinski Test
(+) Inverted Supinator Sign
-Age > 45 years

1 positive: Sn .94, Sp .31, +LR 1.4
2 positive: Sn .39, Sp .88, +LR 3.3
3 positive: Sn .19, Sp .99, +LR 30.9
4 positive: Sn .09, Sp 1.0, +LR infinite


Cluster for Cervical Radiculopathy Diagnosis (Wainner et al, 2003):

-Cervical rotation <60 degrees to the affected side
+ Distraction Test
+Spurling’s Maneuver
+ ULNT-Median

3 positive: +LR: 6.1
4 positive: +LR: 30.3


Cluster for Patients with Neck Pain that will Benefit from T-Spine Manipulation (Cleland et al, 2007):
-Symptoms <30 days
-No symptoms distal to the shoulder
-Looking up does not aggravate symptoms
-FABQ Physical Activity Score <12
-Diminished upper thoracic spine kyphosis
-Cervical extension ROM <30 degrees

3 positive: +LR: 5.5
4 positive: +LR: 12
5-6 positive: +LR: >12


Mechanical Traction for Neck Pain (Raney et al, 2009):

-Patient reported peripheralization with lower cervical spine (C4-7) mobility testing
(+) Bakody's Sign
-Age 55+
(+) ULNT A
(+) Cervical Distraction Test

3 positive: Sn .63, Sp .87, +LR 4.81
4 positive: Sn .3, Sp 1.0, +LR 23.1


Note: tests should only be performed by a properly trained health care practitioner.

References:
Cleland JA, Childs JD, Fritz JM, Whitman JM, Eberhart SL. "Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck    pain: use of thoracic spine manipulation, exercise, and patient education." Phys Ther. 2007 Jan. Web. 08/18/2012.

Cleland JA, Flynn TW, Whitman JM. User's Guide to the Musculoskeletal Examination Fundamentals for the Evidence-Based Clinician: Evidence in Motion; 2008.

Cook CE, et al. Clustered clinical findings for diagnosis of cervical spine myelopathy. J Man Manip Ther. 2010; 18(4):175-180.

Puentedura EJ, et al. Development of a clinical prediction rule to identify patients with neck pain, likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther. 2012; 42(7): 577-92.

Raney NH, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009; 18(3):382-91.

Steill IG et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in patients with trauma. N Engl J Med 2003; 349:2510-8.


​Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. "Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy." Spine (Phila Pa 1976) 2003 Jan 1. Web. 08/18/2012.

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Copyright © The Student Physical Therapist LLC 2023
  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test