Testing
1
CERVICAL AND THORACIC SPINAL ASSESSMENT
Testing
If significant physical finding indicates possible nerve involvement, immobilization and immediate transportation to the nearest medical facility are warranted, regardless of whether a total assessment is complete.
Range of Motion Tests
—Assessment potentially includes active ROM, passive ROM, and resisted ROM
—Bilateral comparison should be performed
· Cervical flexion 80–90°
· Cervical extension 70°
· Lateral cervical flexion (left and right) 20–45°
· Cervical rotation (left and right) 70–90°
Manual Muscle Tests
· Muscle Grading
Normal = 5 Full strength
Good = 4 Slight weakness
Fair = 3 Noticeable weakness; + pain
Poor = 2 Gravity only; – pain
Trace = 1 Without gravity
Zero = 0 No contraction
· Muscles
Anterior neck flexors
Anterolateral neck flexors
Posterolateral neck extensors
Upper trapezius
Stress and Functional Tests
· Brachial plexus traction test
· Cervical compression test
· Spurling test
· Cervical distraction test
· Shoulder abduction test
· Vertebral artery test
· First thoracic nerve root stretch
Neurologic Tests
· Babinski test
· Oppenheim test
· Hoffman’s sign
· Dermatomes (normal, hyperesthesia, hypoesthesia, anesthesia, superficial tactile sensation, superficial pain sensation)
o C2 – occipital protuberance
o C3 – supraclavicular fossa
o C4 – acromioclavicular joint
o C5 – lateral upper arm
o C6 – lateral forearm, thumb, 1st finger
o C7 – middle finger
o C8 – 4th and 5th fingers, medial forearm
o T1 – medial upper arm
· Myotomes
o C1-C2 – neck flexion
o C3 – lateral neck flexion
o C4 – shoulder elevation
o C5 – shoulder abduction
o C6 – biceps flexion, wrist extension
o C7 – triceps extension, wrist flexion
o C8 – finger flexion
o T1 – finger abduction
· Reflexes
o Biceps (C5, C6)
o Brachioradialis (C5, C6)
o Triceps (C7, C8)
Vascular
· Carotid pulse
· Radial pulse
· Capillary refill
Activity-Specific Functional Tests
· Performance of active movements typical of the movements executed by the individual during sport or activity participation
· Should assess strength, agility, flexibility, joint stability, endurance, coordination, balance, and activity-specific skill performance
Quick Reference – Tests
Stress and Functional Tests
· Brachial plexus traction test
o Examiner side flexes patient’s (pt) head to one side while applying a downward pressure on the contralateral shoulder
o If test is +, increased pain, radiating through upper arm =
§ Radiating to opposite side of lateral bending: tension of brachial plexus
§ Radiating to same side as lateral bending: compression of cervical nerve root between vertebrae
· Cervical compression test
o Pt is seated
o Examiner standing behind pt with hands interlocking on top of pt’s head; presses down
o If test is +, pain in upper cervical spine, upper extremity, or both = possible facet joint, narrowing of intervertebral foramen, or disc
o Do not perform until r/o cervical fracture or instability!
· Spurling test
o Examiner interlocks hands over top of pt’s head
o Pt extends and laterally flexes cervical spine
o Examiner applies compressive force through cervical spine
o If test is +, radiating pain down arm = nerve root impingement (narrowing neural foramina)
· Cervical distraction test
o Pt is supine and relaxed
o Examiner: one hand under occiput; other hand on top of forehead to stabilize head
o Examiner applies traction to head (distract cervical spine)
o If test is +, relieve/decrease symptoms = compression of facet joint/stenosis
· Shoulder abduction test
o Pt is seated or standing
o Pt is instructed to actively abduct arm so hand is resting on top of head
o If test is +, decreased tension on involved nerve root = herniated disc or nerve root compression
· Vertebral artery test
o Pt is supine, head off table
o Examiner: support pt’s head with hands under occiput
o Examiner extends and laterally flexes cervical spine
o Examiner rotates head toward laterally flexed side and holds for 30 seconds (keep eyes open)
o If test is +, dizziness, confusion, nystagmus, unilateral pupil change, nausea = occlusion of cervical vertebral arteries
· First thoracic nerve root stretch
o Pt positioned with the forearm pronated to 90°
o Pt instructed to abduct the arm to 90° and flex the elbow (should be no symptoms elicited in this position)
o Next, pt must place their hand behind the head, fully flexing the elbow (action stretches the ulnar nerve and T1 nerve root)
o If test is +, pain in the scapular area or arm = T1 nerve root pathology
Neurologic Tests
· Babinski
o Pt is supine with the eyes closed and the leg held in a slightly elevated and flexed position
o Examiner: pointed object is stroked along the plantar aspect of the foot
o Normal sign is for the toes to curl downward in flexion and adduction
o If test is +, extension of the big toe and abduction (splaying) of the other toes = upper motor neuron lesion
· Oppenheim
o Pt is supine
o Examiner runs a fingernail along the crest of the anteromedial tibia
o If test is +, the great toe extends and the other toes splay or hypersensitivity to the test =
upper motor neuron lesion
· Hoffman’s sign
o Examiner holds patient’s middle finger and briskly flicks the distal phalanx
o If test is +, the interphalangeal joint of the thumb of the same hand flexes = upper motor neuron lesion