_________________________________________________________________________ Neck Pain in Adults
PROVOCATIVE TESTS: DESCRIPTION AND DIAGNOSTIC USE
Test
Description
Cervical radiculopathy Spurling
Radicular pain reproduced by lateral flexion and rotation to affected side with axial compression of the head Ipsilateral cervical radicular symptoms relieved by placing symptomatic arm on head (abduction) Radicular symptom relief when examiner grasps patient’s head under occiput and chin and applies 10–15 kg of axial traction force Radicular pain reproduced by forced expiratory effort with mouth and nose closed
Shoulder abduction Neck distraction test
Valsalva maneuver Jackson compression
Downward pressure on head with lateral flexion
Upper limb tension test 1 (median nerve bias)
Radicular pain reproduced with scapular depression; shoulder abduction; forearm supination, wrist and finger extension; shoulder external rotation; elbow extension; contralateral followed by ipsilateral cervical lateral flexion Radicular pain reproduced with scapular depression; elbow extension; lateral rotation of the whole arm; wrist, finger, and thumb extension Radicular pain reproduced with scapular depression; elbow extension; medial rotation of the whole arm; wrist, finger, and thumb flexion Radicular pain reproduced with scapular depression; shoulder abduction; shoulder external rotation; wrist and finger extension; elbow flexion; shoulder abduction Radicular pain reproduced with scapular depression; elbow extension; shoulder extension; ulnar deviation of the wrist with thumb flexion. Either medial or lateral rotation of the arm could further sensitize this nerve.
Upper limb tension test 2A (median nerve bias) Upper limb tension test 2B (radial nerve bias) Upper limb tension test 3 (ulnar nerve bias) Upper limb tension test (musculocutaneous) Cervical myelopathy Lhermitte sign Hoffmann sign (also for spinal stenosis)
Electrical-like sensations down spine or arms with passive flexion of neck Reflex contraction of thumb and index finger from nipping of the middle finger
Babinski sign
Stimulation of the foot sole elicits dorsiflexion of hallux, or dorsiflexion and abduction of other toes
Hyper-reflexia
Over-reactive deep tendon reflexes
Clonus
More than two repetitive beats during wrist or ankle dorsiflexion movements
Facet joint pain Paraspinal tenderness
Paraspinal > midline pain with palpation. The only test that identifies facet pain, distinguishes from diskogenic pain, and predicts treatment response.
Source: [2; 29; 49; 51; 56]
Table 3
Plain Radiography X-ray images are taken from different anatomic views to identify the following abnormalities [51]: • Anteroposterior: Tumors, osteophytes, fractures • Lateral: Stability, spondylosis (spurring, disk space narrowing) • Odontoid: C1–C2 stability, odontoid process (bony projection of C2, prone to fracture) • Bilateral oblique: Degenerative disk disease, foraminal encroachment by osteophytes • Flexion-extension: Subluxations, cervical spine instability
A standard cervical spine x-ray series captures anteroposterior, lateral, and odontoid views [19]. All five views are used to evaluate the intervertebral foramen [41]. Radiographs of the lateral cervical spine may show straightening or reversal of the normal lordotic curve, which can represent spasm, guarding, or splinting of muscles that stabilize the neck [41]. Cervical spine x-ray is indicated for any significant trauma, pain, or cervical spine-related dysfunction; to rule out fracture; or screen for stenosis in symptomatic patients [16; 41; 59].
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MDKY1626
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