HEAD AND CERVICAL SPINE

Tinel’s Sign

 

• Patient Position: Seated

• Examiner Position: Standing in front of patient

• Examiner Action: Tap at Erb’s point (2-3cm above clavicle in front of the transverse process of C6 vertebra

• Positive findings: Tingling or shooting pain down the affected arm can indicate brachial plexus pathology

 

 

 

 

 

 

Vertebral Artery Test

 

• Patient Position: Supine with the head off table

• Examiner Position: Seated at the patient’s head with their hand under the occiput to support the head

• Examiner Action: Passively extend and laterally flex the head to one side. Rotate the head in the direction of lateral flexion and hold for 30 seconds

• Positive findings: Dizziness, confusion, nystagmus, pupil changes, or nausea can indicate an occlusion of the vertebral arteries in the cervical spine

 

 

Spurling’s Test

 

• Patient Position: Seated

• Examiner Position: Standing behind patient

• Examiner Action: Patient laterally flexes to the right or left while the examiner presses downward on the head. Repeat with opposite side.

• Positive findings: pain radiating down the arm can indicate nerve root impingement or stenosis

 

 

 

 

 

Cervical Compression

 

• Patient Position: Seated

• Examiner Position: Standing behind the patient

• Examiner Action: Presses directly down on head.

• Positive findings: Radiating pain in the upper extremity can indicate facet joint pathology or stenosis

 

 

 

 

 

 

Cervical Distraction

 

• Patient Position: Supine on table

• Examiner Position: At the patient’s head with hands holding the forehead and the base of the skull

• Examiner Action: Apply traction to distract the c-spine.

• Positive findings: Diminish of symptoms can indicate facet joint compression or stenosis

 

 

 

 

 

 

Valsalva’s Maneuver

 

• Patient Position: Seated

• Examiner Position: In front of patient

• Examiner Action: Instruct the patient to bear down as if having a bowel movement

• Positive findings: Pain present can indicate a disc herniation

 

 

 

 

 

 

Brachial Plexus Traction

 

• Patient Position: Standing or seated

• Examiner Position: Standing behind patient

• Examiner Action: Passively laterally flex the patient’s head to one side

• Positive findings: Radiating pain in the upper arm. If pain is on the same side, it could indicate stenosis or nerve compression. If pain is on opposite side, it could indicate brachial plexus pathology

 

 

 

Babinski

 

• Patient Position: Long-seated with foot out

• Examiner Position: At the foot of the patient

• Examiner Action: With a sharp object, stroke the foot from the heel to the great toe

• Positive findings: If the great toe extends or the rest of the toes splay can indicate an upper motor neuron lesion due to injury or trauma.