Documente Academic
Documente Profesional
Documente Cultură
Chapters 3 & 4
Cerebrobasilar Testing
Positional change in the cervical spine compresses the vertebral artery at the atlantoaxial junction on the side opposite of rotation. In the normal patient, the diminished blood flow does not cause any neurological symptoms, such as dizziness, nausea, tinnitus, faintness, or nystagmus.
Barre-Lieou Sign
Procedure: Patient rotates head from one side to the other. Positive Test: Vertigo, dizziness, visual blurring, nausea, faintness, nystagmus. Structure affected: Vertebral artery on the same side of head rotation. Consider patency of the carotid arteries and the communicating cerebral artery circle.
Barre-Lieou Sign
Maignes Test
Procedure: Patient extends and rotates the head and holds that position for 15 40 seconds. Repeat on opposite side. Positive Test: Vertigo, dizziness, visual blurring, nausea, faintness, and nystagmus. Structures Affected: Vertebral, basilar, or carotid artery stenosis or compression.
Maignes Test
Dekleyns Test
Procedure: Patient supine, head off table. Instruct pt. to hyperextend and rotate head. Hold 15 to 30 seconds. Repeat opposite. Positive Test: Vertigo, dizziness, visual blurring, nausea, faintness, and nystagmus. Structures Affected: Vertebral, basilar, or carotid artery stenosis or compression.
Dekleyns Test
Hautants Test
Procedure: Pt. Seated, eyes closed, extend arms to front with palms up. Pt. extend and rotate head. Positive Test: Patient loses balance, drops arms, and will pronate the hands. Structures Affected: Vertebral, basilar, or carotid artery stenosis or compression.
Hautants Test
Underburgs Test
Procedure: Pt. standing. Close eyes and assess equilibrium. Stretch arms and supinate hands. Then pt. marches in place. Then pt. extends and rotates head while marching. Then opposite side.
Underburgs Test
Positive Test: Patient loses balance, arms drift, hands pronate. Vertigo, dizziness, visual blurring, nausea, faintness, and nystagmus. Structures Affected: Vertebral, basilar, or carotid artery stenosis or compression.
Underburgs Test
Hallpikes Maneuver
Procedure: Pt. supine with head extended off table. Support head and move it into extension. Then laterally flex and rotate. Hold 15 to 40 seconds. Repeat opposite. Then hang head in free hyperextension.
Hallpikes Maneuver
Positive Test: Vertigo, dizziness, visual blurring, nausea, faintness, and nystagmus. Structures Affected: Vertebral, basilar, or carotid artery stenosis or compression.
Hallpikes Maneuver
Hallpikes Maneuver
Categories of Strain
Mild: Slight disruption of muscle fibers with no appreciable hemorrhage and minimal amounts of swelling and edema.
Categories of Strain
Moderate: Laceration of muscle fibers with an appreciable amount of hemorrhage into the surrounding tissues and a moderate amount of swelling and edema. Severe: Complete disruption of the muscle tendon unit, possibly with tearing of the tendon from the bone or a rupture of the muscle through its belly.
Categories of Sprain
Mild: Slight tears of a few ligamentous fibers. Moderate: More sever tearing of ligamentous fibers but not complete separation of the ligament.
Categories of Sprain
Severe: Complete tearing of a ligament from its attachments. Avulsion: A ligament that attaches to a bone is pulled loose with a fragment of that bone.
ODonoghues Maneuver
Procedure: Patient seated. Put the cervical spine through resisted range of motion, then through passive range of motion. Positive Test: Pain during resisted range of motion or isometric muscle contraction signifies muscle strain. Pain during passive range of motion may indicate a sprain of any of the cervical ligaments.
ODonoghues Maneuver
Structures Affected: Cervical spinal muscles and/or cervical spinal ligaments. Since resisted range of motion mainly stresses muscles and passive range of motion mainly stresses ligaments, you should be able to determine between strain and sprain or a combination thereof.
ODonoghues Maneuver
Soto-Hall Test
Procedure: Patient Supine. Press on the patients sternum with one hand. With the other hand, passively flex the patients head to the chest. Positive Test: Local pain could indicate ligament, muscular, ossous pathology or cervical cord disease. Suspect disc defect with radicular symptoms.
Soto-Hall Test
Rusts Sign
Procedure: A patient with severe injury to the upper cervical spine will grasp the head with both hands to support the weight of the head on the cervical spine. The supine patient will support the head while attempting to rise. Positive Sign: The patient stabilizes the head. It might include slight traction.
Rusts Sign
Structures Affected: This could represent severe muscular strain, ligamentous instability, posterior disc defect, upper cervical fracture, or dislocation.
Rusts Sign
Space-Occupying Lesions
Clinical Signs and Symptoms
Cervical pain. Upper extremity neurological symptoms. Lower extremity neurological symptoms.
Valsalvas Maneuver
Procedure: Have the patient bear down as if defecating and focus the bulk of the stress on the cervical spine. Ask if the patient feels pain and have them point to the location.
Valsalvas Maneuver
Positive Test: Local pain with increased pressure could indicate a space-occupying lesion (e.g. disc defect, mass, osteophyte) in the cervical canal or foramen.
Valsalvas Maneuver
Dejerines Sign
Procedure: Patient seated. Instruct them to cough, sneeze, and bear down as if defecating (Valsalvas maneuver). Positive Test: Local pain or pain radiating to the shoulders or upper extremities indicates an increase in intrathecal pressure. Structures Affected: Space-occupying lesion.
Jacksons Compression
Procedure: Laterally flex the head and exert strong downward pressure. Perform b/l. Positive Test: Local pain may indicate foraminal encroachment without nerve pressure or apophyseal joint pathology. Radicular pain may indicate pressure on a nerve root.
Jacksons Compression
Spurlings Test
Procedure: Laterally flex the patients head and gradually apply strong downward pressure. If no pain is elicited, put the patients head in a neutral position and deliver a vertical blow to the uppermost portion of the patients head.
Spurlings Test
Positive Test: Local pain indicates facet joint involvement. Radicular pain indicates nerve root pressure.
Spurlings Test
Distraction Test
Procedure: Grasp beneath the mastoid processes and press up on the patients head. This removes the weight of the patients head on the neck.
Distraction Test
Positive Test: If local pain increases, suspect muscle strain, spasm, ligamentous sprain, or facet capsulitis. Relief of radicular pain indicates either foraminal encroachment or a disc defect.
Distraction Test