Purpose:
Compression @ intervertebral foramen
Compression @ facet
Muscle spasm
Bulging disc
How to perform:
Pt is sitting upright on table or chair
Examiner comes from behind w/ their “shooter” fingers around jaw line on both sides
Examiner than provides a distraction force by pulling its head up
(+): relief of pain or s/s = means possible
Compression @ intervertebral foramen
Compression @ facet
Muscle spasm
Bulging disc
(-): no relief of pain or s/s = means no possible
Compression @ intervertebral foramen
Compression @ facet
Muscle spasm
Bulging disc
Purpose:
Compression @ intervertebral foramen
Facet compression
Muscle spasm
Bulging disc
How to perform:
Pt sitting upright on table or chair
Examiner comes from behind and places both hands on top of pt’s head
Examiner then applies a compressive/axial load to the pt’s head. As the examiner applies the axial load, they are also watching pt’s face for a run
(+): increased pain or neuro s/s = means possible
Compression @ intervertebral foramen
Compression @ facet
Muscle spasm
Bulging disc
(-): no increased pain or neuro s/s = means no possible
Compression @ intervertebral foramen
Compression @ facet
Muscle spasm
Bulging disc
Purpose: Cervical radicular syndrome
How to perform:
Pt is sitting upright in a chair
Pt is then placed in cervical ext and then lateral flexion to affected side
Examiner then applies an axial load on the pt from top of their head
(+): increase pain, neuro s/s, or recreation of s/s = Means cervical radicular syndrome
(-): no increased pain, neuro s/s, or recreation of s/s = Means no cervical radicular syndrome
Purpose: tumor/fx to laryngeal/thyroid nodule
How to perform:
Pt is sitting relaxed
Pt is instructed to swallow and will be observed at all angles
(+): abnormal bulge with swallowing = Means: possible tumor or laryngeal fx or thyroid nodule
(-): no abnormal bulge with swallowing = Means no tumor or laryngeal fx or thyroid nodule
Purpose: Anterior scalene thoracic outlet syndrome
How to perform:
Pt stands with arms in anatomical position at the side.
Examiner finds radial pulse on 1 arm
Bring pt’s shoulder in ER, slight abd, and slight extension.
Pt is then instructed to look up and towards tested arm.
Then have the pt hold their breath for a couple seconds.
(+): loss of radial pulse and/or reproduction of symptoms = Means: thoracic outlet syndrome/more specifically anterior scalene syndrome
(-): no loss of radial pulse or reproduction of symptoms = Means: no thoracic outlet syndrome/more specifically anterior scalene syndrome
Purpose: Pec minor thoracic outlet syndrome
How to perform:
Pt is standing
Find radial pulse on 1 arm
Bring the tested shoulder into Abd 90° and elbow flexion of 90°.
Examiner then slowly ER the shoulder
Once the max ER is reached, have pt look away over the opp. shoulder.
(+): radial pulse disappears as test is performed = Means: Thoracic Outlet Syndrome/more specifically pec minor syndrome
(-): no radial pulse disappearance as test is performed = Means: no Thoracic Outlet Syndrome/more specifically pec minor syndrome
Purpose: Cervical radiculopathy/cervical spondylosis
How to perform:
Pt is sitting upright on table or chair
Pt fully abducts shoulder till hand is on top of head
Pt is instructed to relax the shoulder
(+): decrease in neuro s/s as shoulder relaxes = Means: cervical radiculopathy or cervical spondylosis
(-): no decrease in neuro s/s as shoulder relaxes = Means: no cervical radiculopathy or cervical spondylosis
Purpose: Upper motor n lesion
How to perform:
Pt is seated
Pt’s affected arm is @ side w/ elbow flexed 90° and palm down
Examiner will take 1 hand to hold underneath pt’s forearm to the pt’s palm and have their fingers hanging off
Pt is instructed to relax/be dead weight and to let fingers hang
Examiner takes other hand to flick the nail of the 3rd digit
(+): thumb and index finger will come together when 3rd digit is flicked = Means: upper motor n lesion
(-): thumb and index finger doesn’t come together when 3rd digit is flicked = Means: no upper motor n lesion
Purpose: Multiple Sclerosis
How to perform:
Pt is sitting in a chair
Pt is instructed to actively flex their neck
(+): zingers down the spine as neck flexion occurs = Means: multiple sclerosis
(-): no zingers down the spine as neck flexion occurs = Means: no multiple sclerosis
Purpose: median n, anterior interosseous n, C5, C6, C7
How to perform:
Pt is supine w/ arms and legs extended
Pt is then passively placed in lateral cervical flx away from tested shoulder
Examiner then pulls tested shoulder down and will maintain the shoulder depression
Examiner then passively abducts shoulder 110°
Examiner then supinates and extends pt’s wrist on tested side as well as extend pt’s fingers
Examiner then slowly extends the elbows
(+): recreation of pain or look of apprehension or increase of radicular s/s = Means: median n/anterior interosseous n/C5/C6/C7 injury or muscle tightness around the nerve
(-): no recreation of pain or look of apprehension or increase of radicular s/s = Means: median n/anterior interosseous n/C5/C6/C7 injury or muscle tightness around the nerve
Purpose: median N/Musculocutaneous N/Axillary N
How to perform:
Pt is supine w/ arms and legs extended
Pt is then passively placed in lateral cervical flx away from tested shoulder
Examiner then pulls tested shoulder down and will maintain the shoulder depression
Examiner abducts pt’s tested shoulder 10°
Examiner then extends pt’s wrist and fingers on tested arm
Examiner will slowly extend the elbow of the tested arm.
(+): recreation of pain or look of apprehension or increase of radicular s/s = Means: median n/musculocutaneous n/axillary n injury or tightness around the nerve
(-): no recreation of pain or look of apprehension or increase of radicular s/s = Means: no median n/musculocutaneous n/axillary n injury or tightness around the nerve
Purpose: Radial n
How to perform:
Pt is supine w/ arms and legs extended
Pt is then passively placed in lateral cervical flx away from tested shoulder
Examiner then pulls tested shoulder down and will maintain the shoulder depression
Examiner will passively abduct pt’s tested arm 10°
Examiner will flx and pronate wrist, flex fingers of tested arm
Examiner will then slowly extend the elbow
(+): recreation of pain or look of apprehension or increase in radicular s/s = Means: radial n injury or muscle tightness around the nerve
(-): no recreation of pain or look of apprehension or increase of radicular s/s = Means: no radial n injury or muscle tightness around the nerve
Purpose: Ulnar N, C8, T1
How to perform:
Pt is supine w/ arms and legs extended
Pt is then lateral cervical flx away from tested shoulder
Examiner pull’s tested shoulder down and will maintain it
Examiner will ER pt’s tested shoulder and then flx the tested elbow
Examiner will then supinate pt’s forearm and rotate pt’s wrist to shoulder
Examiner will extend wrist and fingers
Examiner uses their thigh to walk shoulder to 90° of abduction
(+): recreation of pain or look of apprehension or increase in radicular s/s = Means: ulnar n/C8/T1 injury or muscle tightness around the nerve
(-): no recreation of pain or look of apprehension or increase in radicular s/s = Means: no ulnar n/C8/T1 injury or muscle tightness around the nerve
Purpose: Bulging disc or spinal cord/n root compression
How to perform:
Pt is sitting on table
Pt is instructed to bear down and blow thru a straw
(+): increase in neuro s/s = Means: possible bulging disc or spinal cord/n root compression
(-): no increase in neuro s/s = Means no bulging disc or spinal cord/n root compression
Purpose: brachial plexus issue/burner/stinger
How to perform:
Pt is seated
Examiner then pushes head and shoulder away from each other to stretch brachial plexus
(+): zinger felt or increased neuro s/s = Means: burner/stinger or brachial plexus issue
(-): zinger felt or increased neuro s/s = Means: burner/stinger or brachial plexus issue
Purpose: Brachial plexus lesions
How to Perform:
Pt is sitting on a chair
Pt is placed in cervical flexion
Examiner taps on both sides of the neck
(+): tingling sensation recreated along neck as tapping occurs = Means brachial plexus lesions present
(-): no tingling sensation recreated along neck as tapping occurs = Means: no brachial plexus lesions