Final Practical (Exams)

Question 1

Spurlings Test

Answer 1

• place pts head in slight extension, then laterally flex pts neck 30° to affected side
• apply a downward axial compression

positive = when pain arising in the neck radiates in direction of corresponding ipsilateral dermatome

high spin and snout

Question 2

Cervical Distraction Test

Answer 2

• patient is supine, PT is seated
• place hands around mastoid process , slightly flex pts neck and pull their head towards you

positive = when pt s/s are reduced with the distraction. must be s/s at rest for this test to work

Question 3

Sharp-Purser Test

Answer 3

• performed first if upper cervical instability is suspected and performed with extreme caution
• pt sits with semiflexed neck, hands go on forehead and spinous process of axis
• positive = c1 will translate forward on C2 in flexion and pressure will reduce it. Laxity, reduction in s/s, clunk

Question 4

Transverse Ligament Test

Answer 4

• can provoke symptoms that were reported in history but not currently present
• pt is supine, PT index fingers are on occiput and spinous process of C2. PT lifts head and C1 anteriorly without flexion/extension
• position is held for 10-20 seconds

Question 5

Positive Transverse Ligament Test

Answer 5

• abnormal pupil response
• eye twitching or nystagmus
• soft end-feel
• muscle spasm
• dizziness
• nausea
• paresthesia of lip face or limb
• lump sensation in the throat

Question 6

Alar Ligament

Answer 6

this ligament prevents coupling of rotation and lateral flexion in C0-C3

Question 7

Alar Ligament Test

Answer 7

• can be performed seated OR supine
• stabilze SP and lamina of C2
• slight compression applied through crown of head
• passive lateral flexion applied through head
• testing contralateral alar ligament
• positive = excessive motion palpated

Question 8

Should have (during alar ligament test)…

Answer 8

• almost no rotation when laterally flexed
• no lateral flexion when rotated

Question 9

Cervical Flexion Rotation Test

Answer 9

• patient is in supine, cervical spine is fully flexed and resting against PT
• pts head is rotated from left to right
• positive = firm resistance, pain provoked, range limited before end range, reproduced s/s, or 10°difference from side to side, less than 32° of motion
• indicates limited rotation of C1 on C2 (AA motion)

Question 10

Median Nerve ULNT

Answer 10

1. shoulder depression and abduction to 110
2. external rotation
3. elbow extension
4. forearm supination
5. wrist extension
6. fingers/thumb extension
7. lateral neck flexion

testing C6-T1 nerve roots

Question 11

Ulnar Nerve ULNT

Answer 11

1. scapular depression
2. shoulder abduction to 100°
3. shoulder ER
4. forearm pronation
5. wrist and finger extension
6. elbow flexion
7. lateral neck flexion

testing C8-T1

Question 12

Radial Nerve ULNT

Answer 12

1. shoulder girdle depression
2. shoulder abduction 20-30°
3. shoulder IR
4. forearm pronation
5. wrist, finger, thumb flexion
6. elbow extension
7. lateral neck flexion

Question 13

Cervical Repositioning

Answer 13

• pt in sitting, about 90cm from target
• with eyes closed, patient will rotate head. then they will try to rotate back to target, trying to get within yellow or green
• three trials are performed
• meaningful error = 4.5”
  other errors include searching for position, overshooting, jerky patterns

Question 14

DNF Endurance Test

Answer 14

1” off table while maintaining chin tuck

min of 20s, shows activation of OA flexion and DNF without SCM and abdominals

Question 15

OA Flexion Testing

Answer 15

• posterior hand induces slight cervical flexion w/traction
• anterior hand on forehead, 20-30° of rotation, then bring into more retraction
• testing the side the head is rotated towards, and if there is restrictions

Question 16

OA Extension Testing

Answer 16

• grasp pts head and induce upper cervical extension
• 20-30° of rotation and then translate into more protraction
• testing the side the head is rotated towards

Question 17

Cervical Rotation - Lateral Flexion Test

Answer 17

Rotate head away from affected side and laterally flex head

if 1st rib elevated/hypomobile, lateral flexion will be limited b/c 1st rib is blocking motion

Question 18

PPIVMs

Answer 18

• for C2-C7 segmental assessment
• therapist supports pts head with fingertips
• flex upper cervical to begin palpation at C2
• continue to flex slightly more as you work down the spine to C7
• rotate and laterally flex each segment

looking for symmetry, mobility, pain