56 Differential Diagnosis in Physical Therapy of Upper Extremity and Lower Quadrant: Summary
3. Cervical distraction test ○ Examiner grasps the chin and occiput ○ Patient’s cervical spine is flexed to a position of comfort ○ Gradually apply distraction force to 14 kg ○ Positive Test : Abolish or reduce symptoms 4. Upper limb tension test (ULTT)—median nerve ○ Scapular depression ○ Shoulder abduction/external rotation ○ Supination ○ Elbow extension ○ Finger/wrist extension ○ Cervical lateral flexion ○ Positive Test : Any ONE of the following ■ Reproduction of symptoms ■ Side-to-side difference of greater than 10 degrees in elbow extension ■ Contralateral cervical lateral flexion increases symptoms or ipsilateral lateral flexion decreases symptoms Cluster for Cervical Radiculopathy • Cervical rotation great than 60 degrees to affected side • + Distraction test • + Spurling’s • + ULTT Median Three positives (65% Post-test probability), Specificity: .94 Four positives (90% post-test probability), Specificity: .99 ULTT was most useful single test in ruling out CR (Sen: .97) THORACIC SPINE Primary thoracic spine pain disorders comprise approximately 15% of all back/spine complaints. Compared to cervical/lumbar spine, research is lacking. As a result, there is less evidence available for the evaluation and management of thoracic spine disorders. History • Outcome measures: There are no validated region specific outcome tools for thoracic spine; the following are recommended but require validation
Cervical Spine Red Flags Neoplastic: • Age over 50 years
• Previous history of cancer • Unexplained weight loss • Constant pain, not relieved with rest • Night pain Vertebral Artery Insufficiency: • Drop attacks • Dizziness • Dysphasia • Dysarthria • Diplopia • Positive cranial nerve signs • Ataxia • Nausea Cervical Examination • Palpation • Pain scale • Key muscle testing • Neurological examination ○ Deep tendon reflexes (DTRs) ○ Sensation ○ Cranial nerve testing
• Cervical range of motion (ROM) testing ○ Flexion/extension: 0–45/50 degrees ○ Rotation: 80 degrees ○ Lateral flexion: 45 degrees Cervical Spine Special Tests Cervical clearing test: AROM with overpressure in all directions 1. Cervical rotation ○ Seated active rotation toward painful side ○ Measured with standard goniometer ○ Positive Test : Less than 60 degrees 2. Spurling’s : Patient seated ○ Passively side-bending head toward painful side ○ Apply manual overpressure 7 kg to the head ○ Positive Test : Patient’s symptoms are reproduced
Powered by FlippingBook