Complete the table below
NAME OF TEST
Cervical Axial Compression
Cervical distraction test
Cervical Flexion Compression test
Cervical Rotation Compression test
Cervical Lateral Flexion Compression
test
Cervical Maximal Compression test
Shoulder Depression test
Shoulder abduction test (Bakody’s)
Valsalva test
Lhermittes sign
INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS
TEST LOAD?
Used to test cervical spine facet joints. It can also be useful in
reproducing nerve root compression symptoms in the cervical
spine.
Used in accessing facet joint integrity as well as nerve root
compression. By releasing pressure, if it does give patient relief it
suggests the above.
Dural sac, meninges, spinal cord and nerve roots are elongated
under a tensile load. (Stretching of an inflamed dural sac or injured
spinal cord will cause pain at the level of irritation)
The test is positive if, on testing, pain radiates into the arm. This
indicates pressure on a nerve root. The pain distribution can give
some indication of which nerve root is affected
This indicates pressure on a nerve root. The distribution of pain
altered sensation can give some indication as to which nerve root is
involved.
Axial compression reduces the size of the intervertebral foramen,
compressing vessels and nerves. The IVF is further compressed
with rotation, lateral flexion and extension all to the same side.
Facet joints and intervertebral discs are also significantly loaded.
Nerve root and brachial plexus tension is increased both by lateral
flexion by depression of the shoulder. Rotation of the head away
from the affected shoulder increases tension on the brachial plexus.
The facets and cervical discs are compressed on the concave side
of the neck and ligaments are stretched on the convex side. The
lateral neck flexors as a group can be length tested for tightness
Reduces neurological tension in the nerve roots, spinal nerves and
brachial plexus as well as decreasing intra-foraminal pressure. To
assess patient for radiculopathy.
Performed to elicit radicular pain by increasing pressure, to
determine if this is the cause of patient’s lower back pain is due to
herniation or if there are signs of inter-ventricular foramen
encroachment.
(forward flexion of the head) A positive test is indicated by a sharp
pain down the spine and into the upper and lower limbs. It is

Brachial plexus tension test (Doorbell)
Cervicogenic dizziness
Adson’s test
Halstead test (reverse Adson’s)
Wright’s test (hyperabduction)
Costoclavicular test (Edens)
Provocation elevation test (Roos)
Slump Test
indicative of dural or meningeal irritation to the spine.
Irritating tissue deep to the cervical spine may reproduce a
somatic referral pattern to the midthoracic area. In
addition, the cervical nerve roots, especially C5 and C6,
may be irritated by this procedure. Tractioning or
compressing these nerve roots may increase peripheral
symptoms in patients with existing radicular neuropathy.
Vestibular apparatus is held stationary to differentiate cervicogenic
vertigo from vestibular vertigo and to diagnose a cervical joint
dysfunction
Pressure to the brachial plexus and subclavian artery to examine
for neurovascular compression (thoracic outlet syndrome) caused
by a cervical rib or anterior scalene muscle syndrome (assessing
radial pulse)
Compression just above first rib to compress neovascular bundle
(assessing radial pulse)
(Pectoralis minor stretched) axillary artery or brachial plexus
compression (assessing radial pulse)
The examiner palpates the radial pulse and then draws the patient’s
shoulder down and back. The patient's head is flexed, If this test
causes a reproduction in the patient’s symptoms with a
disappearance of the radial pulse, the test is positive for thoracic
outlet syndrome
The patient elevates both arms above the horizontal and is asked to
rapidly open and close the hands 15 times.
If fatigue, cramping, or tingling occurs during the test, the test is
positive for vascular insufficiency and thoracic outlet syndrome.
The patient is asked to slump so that the lumbar and thoracic spine
go into full flexion. The examiner maintains the patient’s chin in
neutral position to prevent head and neck flexion. The examiner
then uses one arm to apply over-pressure and maintain flexion of
the lumbar and thoracic spine. While this position is held the patient
is then asked to flex the cervical spine and head as far as possible.
The examiner then applies over-pressure to maintain flexion in all
three parts of the spine using the same arm to maintain over-
pressure in the cervical spine. With the other hand, the examiner
 then holds the patient’s foot in maximum dorsiflexion. While the
examiner holds these positions, the patient is asked to actively
straighten the knee as much as possible. The test is repeated with
the other leg, and then with both legs together.

If the patient is unable to fully extend the knee because of pain, the
examiner releases the pressure on the cervical spine and the
patient actively extends the neck. If the knee extends further and
the symptoms decrease with neck extension, then the test is
considered positive for increased tension in the neuromeningeal
tract.

Passive Scapular Approximation

T1-T2 compression and stretching of the serratus anterior muscles

Percussion
Tapping on the effected rib to reproduce pain as a way to locate the
area of breakage on the suspected rib.
Rib Fracture Screen
Use percussion to locate a fracture or tools such as tuning forks

Adam’s Forward Bending Test

Look for any asymmetry of the chest wall, inequality of the scapulae
and differences in the levels of the shoulders. A useful sign of
scoliosis is unequal shoulder levels and apparent ‘winging’ of the
scapula
Ott Sign
With the patient standing, the examiner marks the C7 spinous
process and a point 30 cm inferior to it. This distance should
increase by 2-4 cm in flexion and decrease by 1-2 cm in extension.
Degenerative inflammatory processes of the spine restrict spinal
mobility and range of motion. An alternative method is to measure
the smallest finger-to-floor distance with the knees extended.
Chest Expansion
The patient is seated. The examiner places a tape measure around
the patient’s chest at the T4 level. The patient fully exhales and the
measurement is taken. The patient then fully inhales and a second
measurement is taken and the difference between the two
measurements is noted.

In the normal adult male the difference will be at least 5cm, and for
females at least 3.5cm. A decreased measurement may indicate
 an ankylosing condition such as ankylosing spondylitis.
Beevor’sSign
This is a sign of functional paralysis consisting of inability of the
patient to inhibit the antagonistic muscles. Ask the patient to lift
their head and shoulders slightly from the bench. Upward deviation
of the umbilicus on attempting this (caused by contraction of the
upper but not the lower abdominal muscles), may be indicative of a
spinal cord lesion in the region of the lower thoracic vertebrae. The
umbilicus should normally stay relatively still.

Abdominal Reflexes
To assess abdominal reflexes, the patient is positioned comfortably
in a supine position with the abdomen exposed. The skin of each
quadrant is stimulated.

Normally stimulation should cause the abdominal muscles to

involuntarily contract, resulting in movement of the umbilicus in the
direction of the quadrant being stimulated (reflex can be absent
due to obesity, previous surgery, in the multiparous female and with
increasing age)

Pathological absence of the normal response suggests thoracic

spinal cord compression on the side of the diminished reflex.

Upper abdominal muscles are innervated by T7 through T10 nerve

roots and the lower abdominal musculature is innervated by T10
through L1 nerve roots helps the examiner identify the approximate
level of involvement