Download Head and Back Special Tests and other Rehab Assessments and more Study notes Physical Medicine and Rehabilitation (PM&R) in PDF only on Docsity!
CERVICAL SPINE
Houses nerve roots
PALPATION
- Assess for tenderness and swelling (heat) Posterior * Supine (recommended for comfort) - Head is resting on examiner’s hand and palpates the structures using fingers
Landmarks to palpate: o Occipital protuberance Posterior center of neck o C1 (no spinous process) (^) Move inferior, find a dip o C2 to C Continue moving inferiorly; find 1st^ hard surface below dip *NOTE: IF NOT PALPABLE, FLEX PATIENT’S NECK
o C6-C7 (most prominent) In neutral position - C Extend neck on supine – C o Facet Joints From spinous process, move half and inch L and R Assess symmetry of how it feels and what pt feels o Levator Scapulae Superior Medial Border of Scapula (SMB of scap) Palpate: Origin- SMB of scap Insertion- transverse process of C1- o Upper Trapezius (very common mm affected on cervical pain) Palpate and press down above levator scapulae’s origin (bilaterally) o Sub- occipital Muscles
Lateral Side o Mastoid Process Below ear Insertion of SCM o Transverse processes of cervical spine Inf of mastoid Follow a lordotic cruve o Cervical Lymph Nodes and Carotid Artery Anterior to transverse P. and SCM (^) Fluctuates BP if palpated AVOID TOUCHING! o TMJ Gently press anerior ear lobe Anterior o Hyoid Bone Palpate trachial notch then move superiorly o Thyroid Gland Lateral to Hyoid o SCM O: clavicle and sternum I: mastoid process Ask pt to rotate neck to opposite side If wala, try to resist cervical neck flexion with the pt’s head rotated to one side o 1 st^ rib Below clavicle Assess tenderness and; Rib mobility: Ask patient to inhale and exhale while palpating
RANGE OF MOTION Need: Goniometer and Tape measure Flexion o Goniometer Sitting/ supine F: external auditory meatus P: aligned to skull, perpendicular to roof D: nares (nose holes) Normal ROM: 0- EF: Firm
Grade 3 Grade 4,
Grade 2,1,
Compensatory action: Flexes thoracic region; Thoracic and lumbar area should stay flat on the chair
o Tape Measure Landmarks: tip of chin and trachea/notch Ask pt to bend chin towards the chest, then measure NROM: 1-4 cm
Extension o Goniometer Same landmarks to flexion Proximal arm stays in place do not align to head (^) NROM: 0- o Tape measure Same landmarks to flexion NROM: 18-22 cm Passive: push chin upwards
Lateral Flexion (GONIOMETER only) o Goniometer F: palpation of C P: aligned to thoracic spine D: skull Bilaterally flex NROM: 0-22(<= problem) Flexible pt: up to 30 o Tape Measure Landmarks: Mastoid & AC jt NROM: 11-13 cm
Rotation (GONIOMETER only) o Goniometer F: superior center of skull P: aligned to AC joint D: aligned to bridge of nose NROM: 0- Assess both sides o Tape Measure Chin to AC jt NROM: 11-
MANUAL MUSCLE TESTING
Capital Extension (SKULL EXTENSION) o 3 – prone; head dangling supporting the chin with one hand Ask patient to look at wall infront o 4,5 – prone; head dangling Apply resistance at the back of skull o 2,1,0 – supine; head flat on the bed Place both hands at the back of pt’s head; ask pt to do the movement and palpate capital ext muscles PT: at head of pt Instruct: “Look at me”
Single SCM Isolation o 3 – supine Cervical flexion + rotation to opposite side Lift off the head and rotate to dir. o 4,5 – supine resist the temple downwards o 2,1,0 – supine Palpate SCM
Cervical Rotation o 3 – supine Ask pt to rotate the head opposite to the tested side: R rotation- head to the L L rotation- head to the R o 4,5 – supine Resist at the temple Ask pt to rotate o 2,1,0- supine Long sitting against the wall Palpate muscles o Compensatory motion: Moves thorax together with the head
Grade 3 Grade 4,5^ Grade 2,1,
SPECIAL TESTS
NEUROLOGICAL
Brachial Plexus Compression Test o General test to rule in neuro conditions o Assess nerve root compression o Procedure: Pt sitting, grab one side of upper traps and squeeze o (+)Sign: radiating pain down to UE = Mechanical Cervical Lesions Cervical Distraction Test o Distraction of vertebrae relieves tension on nerve roots o Procedure: Pt sitting; place one hand at chin & other hand at occipital ridge Apply distraction force upwards o Increase pain = mm spams, lig or mm strain, dural irritability or disc herniation--> do another specific ST to rule in another condition o (+)Sign: relief of symtoms = Cervical Radiculopathy Spurling’s Test o Opposite of cervical compression o Procedure: Sitting Place head on Lateral flexion to the affected side then compare other side 3 Stages
- Compression of head in neutral
- Compression with extension
- Compression with extension and rotation to the affected side o (+)Sign: Radiating pain (neck-->UE) = Radiculitis/Cervical Radiculopathy o Reverse Spurling’s Sign pain on unaffected side = mm spasm, tightness
Jackson’s Compression Test o Modified Spurlings test o Procedure: Sitting Passively rotate pt head & apply compressive force, then do on the other side o (+) Sign: radiating pain = Cervical Radiculopathy o Relief of pain = ?? Shoulder Abduction (Relief) Test o aka Bakody’s Sign o Procedure: Sitting Abduct arm fully Place FA on top of head o (+) Sign: decrease in symptoms = Cervical Radiculopathy (C5-C6) o If pain increases = excessive pressure in interscalene triangle Shoulder Depression Test o Procedure: Flex head to one side Depress SH o (+)Sign: radiating pain = formainal encroachment (Osteophytes, adhesions, hypo-mobile joint capsules) ULTT 1 (PASSIVE) o MAIN o Procedure: Depress shoulder Extend wrist Abd sh – 110 Extend elbow HD: contralat flexion ULTT 2 (PASSIVE) o MAM o Prcedure: Depress shoulder FA pronate Shoulder abd- 10 Extend wrist Extend elbow HD: contralat flexion
pain = nerve root lesions or space occupying lesion o If light headed = terminate test (Vertebrobasilar Artery Probs)
Underburg Test o Procedure: Standing SH forward flex, FA supinated Eyes closed 10-20 seconds Side flex head to one side Ask pt to march in place o (+) Sign: (^) dropping of arms, loss of balance, pronation of FA = decreased blood supply to brain
NOTE: IF PATIENT MANIFEST THESE RED FLAG
SIGNS DURING UMNL TEST, STOP AND REFER TO
PHYSICIAN
Hallpike-Dix Test o Procedure: Long sitting Make sure that if pt lies down, head is dangling Rotate head to affected side Lie down the pt with head dangling Place neck in full extension o (+)Sign dizziness and nystagmus = Benign Paroxysmal Positional Vertigo BBPV (problem in ear canal)
*Nystagmus- inv. mov’t of pupils L&R Sharp Purse Test o Procedure: One hand at forehead Other hand, thumb at axis C2, knuckles at spine of C3- C Ask pt to flex cervical spine Apply backward force to the forehead o (+)Sign head slides backward during movement = Subluxation of Atlas o Insert table
Cervical Flexion Rotation Test o Procedure: Supine Bend head into full flexion Rotate fully to R and L (C1- c2 isolation) *Usually uses CROM or goniometer *Retdems: Compare movement of R and L--> use bridge of nose as the reference point & mov’t should be equal ( degrees) o (+) = C1-C2 joint hypomobility
