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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
SPECIAL TESTS Special Test L’hermitte’s Sign (Phenomenon)
Purpose
Technique
Result Interpretation
To determine a disturbance of the cervical spine dorsal column
Position: Seated The client actively flexes the cervical spine
Positive test = reports of “electricity” or pins and needles sensation down the spine, often described as shock- like sensation Clinical significance: A positive test has been linked to myelopathy (spinal cord compression), multiple sclerosis, cervical spondylitis, trauma, or any disturbance of the dorsal column; undiagnosed pathology needs to be further evaluated to determine safety of PT treatment Level of evidence for specific treatment is low and varies according to etiology Positive test = reproduction of pain, particularly radiating pain Clinical significance: Compression of the cervical spine compromises the foraminal space, thus irritating the nerve root; this helps clinicians identify the source of the symptoms Positive test = reduction of pain and/ or centralization of symptoms Clinical significance: Decompression of the cervical spine provides relief, especially if Spurling’s test was positive; if the cervical foraminal distraction test is positive (painful), possible spinal ligament tear, annulus fibrosis tear, excessive inflammation, large disk herniation, or the subject is muscle guarding Test is scored positive or negative Positive = 5: to 10-degree change in cervical position, inability to hold the position properly, or inability to hold for 60 seconds Negative = successful performance for 60 seconds
Spurling Test/ Cervical Compression Test
To determine involvement of
Seated with the head in neutral position, the examiner places both hands on top of subject’s head; an axial load is applied to promote compression of the cervical spine Repeat this process with slight extension and side bending toward the unaffected side if applicable, then to the affected side Seated or supine with the head in neutral position, the examiner places hands on the lateral skull bilaterally A controlled distraction force is applied with the examiner’s hands in attempts to increase
cervical nerve roots at the intervertebral foramen
Cervical Foraminal Distraction Test
To determine involvement of
cervical nerve roots and assess general cervical mobility
intervertebral space and decompress facet joints
Neck Flexor Muscle Endurance Test
To determine the endurance of the deep neck extensor muscles
Client is prone, with head and neck over the edge of the treatment table One attempt to hold a chin tuck with neutral cervical extension for 60 seconds
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