SPECIAL TEST

CRANIOCERVICAL
FLEXION TEST (CCF)
*Pneumatic pressure device

TEST FOR:

PXS POSITION

PT POSITION/PROCEDURE

POSITIVIVE SIGN

TESTS FOR CERVICAL MUSCLE (DEEP NECK FLEXORS) STRENGTH:

Deep cervical
SUPINE
1. Pressure device is inflated

Px cannot increase

flexor muscle

pressure to at least 26

Knees bent (crook

lying)
Head and neck in

midrange
An inflatable

function

is needed

pressure sensor
placed under the

to 20 mmHg
2. Px flexes the cervical spine
by nodding the head in 5
graded segments of
increasing pressure (22,
24, 26, 28 and 30 mmHg)
3. Holds each for 10 secs
with 10 secs rest between

cervical spine

each segment

mmHg;
Unable to hold a
contraction for 10 secs;
Uses the superficial
neck muscles or
extends the head
N: young and middleaged pxs able to
increase pressure

SUPINE IN CROOK

DEEP NECK FLEXOR

between
Skin folds separately

LYING

(due to loss of chin

tuck);
Pxs head touches the
PTs hand test is
terminated
N: Hold for: 39 secs for
male and 29 secs for
female

TESTS FOR NEUROLOGICAL SYMPTOMS

+ BRACHIAL PLEXUS
(TENSION/COMPRESSION
) TEST
DISTRACTION TEST

Cervical

SUPINE/SHORT-

radiculopathy;

SITTING

1. Places one hand under the

pxs chin;

Pain is relieved or
decreased

Check radicular

2. The other hand around the

signs

occiput
3. Slowly lift the pxs head
apply traction to the

FORAMINAL
COMPRESSION
(SPURLINGS) TEST

cervical spine
STANDING BEHIND THE PX

Pain or reproduction of

Laterally flexes

1. Presses straight down on

symptoms+

(should only be

cervical spine

used to possibility

unaffected side

the head
2. 1ST STAGE compression

Pain radiates into the

of cervical fracture

first, followed by

or dislocation has

affected side

Nerve root

SITTING

impingement+

been ruled out)

with head in neutral

3. 2ND STAGE compression
with head in EXT, and the
final stage is with head in

arm toward which the

head is side flexed
during compression

EXT and ROT to the

unaffected side, then to
the affected side with
compression
4. 3RD STAGE closely follows
the test as described by
SITTING

JACKSONS

Spurling
1. Px rotates to the head to
the affected side
2. PT then apply compression
3. Then to the normal side;

COMPRESSION TEST

apply compression test

SITTING

Rotates head to the

affected side
Pulls the chin down
into the hollow

SCALE

above the clavicle

Pain radiates into the

arm
*Pain distribution can
give some indication of
which nerve root is
affected
+

NE CRAMP TEST

flexing the cervical

Radicular

SHOULDER
ABDUCTION (RELIEF)
TEST

spine
SITTING/SUPINE

*can be passive (PT) or active

Decrease in or relief of

symptoms (C4 or

(px)

symptoms

C5 nerve roots)+

1. Abducts shoulder
2. Hand or forearm rests on

SITTING

top of the head

1. Side flexes the pxs head to

one side
2. Applies a downward
pressure on the opposite
shoulder
SHOUL
DER DEPRESSION
TEST
Brachial

SITTING

plexopathy

1. PT taps the area of the

Slight lateral flexion

brachial plexus along the

Tingling sensation in
distribution of nerve

nerve trunks

TINEL
SIGN FOR BRACHIAL
PLEXUS LESION
UPPER LIMB

3.

1. PT asks the px to take a

Increased pain

NEURODYNAMIC
(TENSION) TESTS
(BRACHIAL PLEXUS
TENSION OR ELVEY
TEST)

VALSALVA TEST

SITTING

Relaxed

deep breath

2. Hold it while bearing down

(tighten abdominal
bowels), as if moving the
bowels
TESTS FOR UPPER MOTOR NEURON LESIONS (CERVICAL MYELOPATHY)
Spinal cord
LONG LEG SITTING
1. PT passively flexes pxs

Sharp, electric shock-

Possible upper

head and one hip

like pain down the

motor neuron

simultaneously leg kept

spine and into the

lesion

straight

upper or lower limbs

LHERM
ITTE SIGN

ROMBERG TEST

Upper motor

STANDING

neuron lesion+

TEN SECOND STEP

STANDING

BARRES TEST

HAUTANTS TEST

Body begins to sway

eyes
2. Position is hold for 20 30

excessively

secs
1. PT asks px to step in

Px loses balance
+

place
2. Not holding to any object*
3. Number of steps in 10 secs

TEST

1. PT asks px to close the

is counted
TEST FOR VASCULAR SIGNS (VASCULAR CLEARING TESTS
STANDING

One arm slowly falls

Shoulder forward

with simultaneously
forearm pronation

flexed to 90
Elbows straight
FA supinated,

palms up
EC (eyes closed)
Hold position for 10

20 secs
SITTING

1. Px forward flexes both

arms to 90

*1-3: arms move, the

cause is nonvascular

2. EC
3. PT watches for any loss of

*4-5: wavering of the

arm position
4. PT asks px to ROT, or EXT

vascular impairment to

and ROT, the neck

5. Hold position with EC
6. Each position be held for

NAFFZIGER TEST

SITTING

10 to 30 secs
STANDS BEHIND PX

arms, caused by
the brain

1. PTs finger over the pxs

jugular veins
2. Compresses the veins for

STATIC VERTEBRAL
ARTERY TESTS

SUPINE/SITTING

30 secs
3. Asks px to cough
In the sitting position:

*2: causes symptoms:

1. Sustained full neck and

sometimes called a

head EXT
2. Sustained full neck and

positive Barre-Lieou

head ROT, right and left

3. Sustained full neck and

*3: DeKleyns test

head ROT with EXT right

and left
4. Provocative movement
position**
5. Quick head movement into
provocative position**
6. Quick repeated head
movement into provocative
position**
7. Head still, sustained trunk
movement left and right(10
to 30 secs)
8. Head still, repeated trunk

sign)

**provocative position
implies movement into
the position that
provokes symptoms

movement left and right

In supine position:
1. Sustained full neck and
head EXT
2. Sustained full neck and
head ROT, left and right
3. Sustained full neck and
head ROT with EXT right
and left
4. Unilateral posteroanterior
oscillation of C1 to C2
facet joints (prone lying)
with head ROT left and
right
5. Stimulated mobilization
and manipulation position
Each position shoulder be

UNDERBURGS TEST

VERTEBRAL ARTERY
(CERVICAL
QUADRANT) TEST

STANDING

Shoulders forward

flexed 90
Elbows straight
FA supinated
EC

SUPINE

held for at least 10 to 30 secs

1. Px marches in places while
holding the extended and
rotated head to one side
2. Repeated with head

Dropping of the arms

Loss of balance
Pronation of the hands

movement to the opposite

side
1. PT passively takes pxs
head and neck into
extension and side flexion
2. Rotates pxs neck to the
same side
3. Holds it for approximately
30 secs

+
TESTS FOR VERTIGO AND DIZZINESS
SITTING
1. PT grasps pxs head
2. Actively rotates pxs head

DIZZINESS TEST

as fas as possible to the R

and then to the L
3. Holding the head at the
extreme of motion for a
short time (10 to 30 secs)
shoulders remain

HALLPIKE-DIX TEST

Benign

LONG-SITTING

Paroxysmal

Head and neck

Positional Vertigo

moved to different

(BPPV)

positions

stationary
4. +
1. Head rotated
approximately 30 to 45
2. PT stands behind px; one

Signs of dizziness and

nystagmus (involuntary
eyes movement)

hand supporting the

head/neck;
3. Other hand supporting the
trunk
4. Px then assisted into
supine position with head
slightly below the
horizontal plane
Position is maintained for 30
to 60 secs
Head rotated to both sides

TEMPERATURE
(CALORIC) TEST

starting with normal side

1. PT alternately applies hot
and cold test tubes several
times just behind pxs ear
on the side of the head
2. Each side is done in turn

Inducement of vertigo

TESTS FOR CERVICAL INSTABILITY (INSTABILITY CLEARING TESTS)

SUPINE
1. PT applies an ANT directed
ANTERIOR SHEAR OR
Head in neutral
force through the POST
SAGITTAL STRESS
TEST

resting on the bed

arch of C1 or the spinous

processes of C2 toT1+

LATERAL FLEXION
ALAR LIGAMENT
STRESS TEST
LATERAL
(TRANSVERSE) SHEAR

TEST
ROTATIONAL ALAR
LIGAMENT STRESS
TEST
SHARP-PURSER TEST

TRANSVERSE
LIGAMENT STRESS
TEST
TESTS FOR UPPER CERVICAL SPINE MOBILITY

TESTS FOR FIRST RIB MOBILITY

TESTS FOR THORACIC OUTLET SYNDROME

Nystagmus, pupil
changes, dizziness, soft
end feel, nausea