Cervical Spondylosis
is a degenerative disorder at the level of the cervical spine. It can be
described as the result of degeneration of the intervertebral discs or
the corpus vertebrae in the cervical region
Spurlings Test Technique
- The patient is seated comfortably while physiotherapist stands behind the patient. The
physiotherapist then interlocks their fingers and rests the volar aspect of both hands on top of
the patient's head. The therapist then laterally flexes the patient's neck 30 degrees to the
affected side and then applies a downward axial compression ensure not to laterally flex the
patient's neck any further.[1]
Positive: when the pain arising in the neck radiates in the direction of the corresponding dermatome
ipsilaterally
In some resources there is reference to test A and B, these variations are both used to assess for
radiculopathy.
Cervical Distraction Test
Provocative Diagnostic Test for the presence of cervical radiculopathy.
Test Position
Supine or sitting upright
Technique
Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's either by
placing each hand around the patient’s mastoid processes, while standing at their head, or place one hand on
their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso,
applying a distraction force[5]
A positive test is the reduction or elimination of symptoms with traction .[5]
Tissues being tested
Neural foramen and joint capsules around the facet joints of the cervical spine. The neck extensor
muscles are also secondarily observed during this test.[3]
Positive Test
If pain is relieved as a result of the movement, then the test is positive for nerve root compression
and facet joint pressure. Determining the grade of the pressure would be decided by the amount of
pressure and pain relieved while performing the test.
Importance of Test
As disc height decreases and bone spurs accumulate, the space for nerves to enter and exit the
vertebral canal gets smaller. The decreased space can result in greater pressure on the nerve roots
or other innervated structures, causing pain and weakness. With distraction, the joint space is
increased to relieve the pressure on the nerve roots, thus decreasing the symptoms.
Neurodynamic Assessment
Purpose
These tension tests are performed to check the peripheral nerve compression or as a part of
neurodynamic assessment. The main reason for using a ULTT is to check cervical radiculopathy.
These tests are both diagnostic and therapeutic. Once the diagnosis of cervical radiculopathy is made
the tests are done to mobilise the entrapped nerve.
Method
Each test is done on the normal/asymptomatic side first. Traditionally for the upper limb, the order of
joint positioning is shoulder followed by forearm, wrist, fingers, and lastly elbow. Each joint
positioning component is added until the pain is provoked or symptoms are reproduced. To further
sensitize the upper limb tests, side flexion of cervical spine can be added[4]. If pain is provoked in the
very initial position, then there is no need to add further sensitizers.
If pain or sensations of tingling or numbness are experienced at any stage during movement into the
test position or during addition of sensitization maneuvers, particularly reproduction of neck,
shoulder or arm symptoms, the test is positive; this confirms a degree of mechanical interference
affecting neural structures.
Test Objective for the Cervical Rotation Test
This test evaluates the amount of available cervical spine rotation and lateral flexion. It is a
combination pattern that incorporates side-bending and rotation.
How to Perform the Cervical Rotation Test
To perform the test have the client assume the starting position by standing erect with feet
together and toes pointing forward. The client rotates the head as far as possible to the
right, then flexes the neck, moving the chin toward the collarbone. Do not allow scapular
elevation and protraction. Repeat turning left.
What to look for in the Cervical Rotation Test
● Make sure the patients’s mouth remains closed throughout all movements.
● Observe from the front and side.
● Normal range is touching chin to mid-collar bone bilaterally without pain.
● Do not coach the movement; simply repeat the instructions if needed.
● Was there pain?
● Could the movement be done?
Spurling's test (also known as Maximal Cervical Compression
Test and Framonial Compression Test)
is used during a musculoskeletal assessment of the cervical spine when looking for
cervical nerve root compression causing Cervical Radiculopathy
( "Cervical radiculopathy is a disease process marked by nerve compression from herniated
disk material or arthritic bone spurs. This impingement typically produces neck and
radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and
upper extremities.)
Performance‐based outcome measures[1]
Movement or activity limitations associated with the patient’s neck pain and be used to assess the
changes in the patient’s level of function over the episode of care. These activities should be
measureable and reproducible. This is commonly referred to as an asterisk sign. Have the patient
perform an activity that produces their symptoms such as looking over their shoulder as if they were
checking a blind spot when driving, and note at which point in the motion symptoms are elicited.
After intervention this can be reassessed to see if symptoms are decreased, or range of motion is
gained which would indicate an improvement in function.
http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1159
http://www.physio-pedia.com/
Neurodynamic_Assessment#Upper_limb_tension_test_1_.28median_nerve_bias.29
http://www.physio-pedia.com/Spurling%27s_Test
http://journals.lww.com/spinejournal/Abstract/2000/03150/
Outcome_of_Patients_Treated_for_Cervical.4.aspx
