Cervical spine tests
- Vertebral artery test
- The examiner carefully extends the patient’s neck, then rotates the head to one side and holds it there for up to 30 seconds. The patient’s eyes are kept open and monitored, and they are usually asked to count backward or speak to check for changes in their voice.
- Tests the integrity of the vertebrobasilar vascular system
- Positive: symptoms of dizziness, dysphagia, diplopia, nystagmus- red flag, and the therapist does not progress with any movements of the cervical spine
- Current evidence questions the validity and reliability of this positional test on its own. Rather than relying on the positional test alone as the standard of care, current frameworks call for a broader cervical arterial dysfunction screen before cervical spine mobilization or manipulation- including patient history, risk factors, blood pressure, and a cranial nerve exam- to identify patients at risk before proceeding
- The examiner carefully extends the patient’s neck, then rotates the head to one side and holds it there for up to 30 seconds. The patient’s eyes are kept open and monitored, and they are usually asked to count backward or speak to check for changes in their voice.
- Flexion rotation test
- Patient in supine with maximal flexion of neck performed with rotation to left and right
- Provocative test for atlantoaxial dysfunction or cervicogenic headache
- Positive: reproduction of headache symptoms or loss of 10 degrees of mobility when comparing left and right rotation (when compared to each side)
- Patient in supine with maximal flexion of neck performed with rotation to left and right
- Spurling’s test (foraminal compression)
- Patient sitting with head laterally bending towards the involved side while the therapist applies pressure straight down
- Confirms cervical root dysfunction
- Positive: pain and paresthesia in a dermatomal pattern of the cervical root
- Patient sitting with head laterally bending towards the involved side while the therapist applies pressure straight down
- Cervical compression test
- Patient sitting and neck passively moved into lateral flexion and rotation to the non-painful side, followed by extension. Repeat the painful side.
- Identifies intervertebral foramen and/or facet dysfunction
- Positive: pain and paresthesia in a dermatomal pattern of cervical root or localized pain in the neck if facet dysfunction
- Patient sitting and neck passively moved into lateral flexion and rotation to the non-painful side, followed by extension. Repeat the painful side.
- Distraction test
- Patient sitting with head passively distracted
- Identifies intervertebral foramen and/or facet dysfunction
- Positive: decrease in symptoms or decrease in upper limb pain
- Patient sitting with head passively distracted
- Lhermitte’s sign
- Patient sitting upright; the therapist passively flexes the patient’s neck (chin toward chest), or the patient actively flexes their own neck
- Identifies upper motor neuron lesions (often associated with multiple sclerosis)
- Positive: a brief, electric shock-like sensation traveling down the spine and into the upper or lower limbs
- Patient sitting upright; the therapist passively flexes the patient’s neck (chin toward chest), or the patient actively flexes their own neck
- Alar ligament test
- Patient seated and therapist palpates C2 spinous process; the therapist passively flexes the upper cervical spine with lateral flexion and rotation
- Tests the integrity of the alar ligament
- Positive: inability to palpate C2 and/or inability to feel movement at C2
- Patient seated and therapist palpates C2 spinous process; the therapist passively flexes the upper cervical spine with lateral flexion and rotation