Testing

CERVICAL AND THORACIC SPINAL ASSESSMENT

Testing

If significant physical finding indicates possible nerve involvement, immobilization and

immediate transportation to the nearest medical facility are warranted, regardless of
whether a total assessment is complete.

Range of Motion Tests

—Assessment potentially includes active ROM, passive ROM, and resisted ROM
—Bilateral comparison should be performed
 Cervical flexion 80–90
 Cervical extension 70
 Lateral cervical flexion (left and right) 20–45
 Cervical rotation (left and right) 70–90

Manual Muscle Tests

 Muscle Grading
Normal = 5 Full strength
Good = 4 Slight weakness
Fair = 3 Noticeable weakness; + pain
Poor = 2 Gravity only; – pain
Trace = 1 Without gravity
Zero = 0 No contraction
 Muscles
Anterior neck flexors
Anterolateral neck flexors
Posterolateral neck extensors
Upper trapezius

Stress and Functional Tests

 Brachial plexus traction test
 Cervical compression test
 Spurling test
 Cervical distraction test
 Shoulder abduction test
 Vertebral artery test
 First thoracic nerve root stretch

Neurologic Tests
 Babinski test
 Oppenheim test
 Hoffman’s sign
 Dermatomes (normal, hyperesthesia, hypoesthesia, anesthesia, superficial tactile sensation,
superficial pain sensation)
o C2 – occipital protuberance
o C3 – supraclavicular fossa
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o C4 – acromioclavicular joint
o C5 – lateral upper arm
o C6 – lateral forearm, thumb, 1st finger
o C7 – middle finger
o C8 – 4th and 5th fingers, medial forearm
o T1 – medial upper arm
 Myotomes
o C1-C2 – neck flexion
o C3 – lateral neck flexion
o C4 – shoulder elevation
o C5 – shoulder abduction
o C6 – biceps flexion, wrist extension
o C7 – triceps extension, wrist flexion
o C8 – finger flexion
o T1 – finger abduction
 Reflexes
o Biceps (C5, C6)
o Brachioradialis (C5, C6)
o Triceps (C7, C8)

Vascular
 Carotid pulse
 Radial pulse
 Capillary refill

Activity-Specific Functional Tests

 Performance of active movements typical of the movements executed by the individual
during sport or activity participation
 Should assess strength, agility, flexibility, joint stability, endurance, coordination, balance,
and activity-specific skill performance

QUICK REFERENCE – TESTS

Stress and Functional Tests
 Brachial plexus traction test
o Examiner side flexes patient’s (pt) head to one side while applying a downward pressure
on the contralateral shoulder
o If test is +, increased pain, radiating through upper arm =
 Radiating to opposite side of lateral bending: tension of brachial plexus
 Radiating to same side as lateral bending: compression of cervical nerve root
between vertebrae
 Cervical compression test
o
Pt is seated
o
Examiner standing behind pt with hands interlocking on top of pt’s head; presses down
o
If test is +, pain in upper cervical spine, upper extremity, or both = possible facet joint,
narrowing of intervertebral foramen, or disc
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o
Do not perform until r/o cervical fracture or instability!
 Spurling test
o
Examiner interlocks hands over top of pt’s head
o
Pt extends and laterally flexes cervical spine
o
Examiner applies compressive force through cervical spine
o
If test is +, radiating pain down arm = nerve root impingement (narrowing neural
foramina)
 Cervical distraction test
o
Pt is supine and relaxed
o
Examiner: one hand under occiput; other hand on top of forehead to stabilize head
o
Examiner applies traction to head (distract cervical spine)
o
If test is +, relieve/decrease symptoms = compression of facet joint/stenosis
 Shoulder abduction test
o
Pt is seated or standing
o
Pt is instructed to actively abduct arm so hand is resting on top of head
o
If test is +, decreased tension on involved nerve root = herniated disc or nerve root
compression
 Vertebral artery test
o
Pt is supine, head off table
o
Examiner: support pt’s head with hands under occiput
o
Examiner extends and laterally flexes cervical spine
o
Examiner rotates head toward laterally flexed side and holds for 30 seconds (keep eyes
open)
o
If test is +, dizziness, confusion, nystagmus, unilateral pupil change, nausea = occlusion
of cervical vertebral arteries
 First thoracic nerve root stretch
o
Pt positioned with the forearm pronated to 90°
o
Pt instructed to abduct the arm to 90° and flex the elbow (should be no symptoms elicited
in this position)
o
Next, pt must place their hand behind the head, fully flexing the elbow (action stretches
the ulnar nerve and T1 nerve root)
o
If test is +, pain in the scapular area or arm = T1 nerve root pathology

Neurologic Tests
 Babinski
o Pt is supine with the eyes closed and the leg held in a slightly elevated and flexed
position
o Examiner: pointed object is stroked along the plantar aspect of the foot
o Normal sign is for the toes to curl downward in flexion and adduction
o If test is +, extension of the big toe and abduction (splaying) of the other toes = upper
motor neuron lesion
 Oppenheim
o Pt is supine
o Examiner runs a fingernail along the crest of the anteromedial tibia
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o If test is +, the great toe extends and the other toes splay or hypersensitivity to the test =
upper motor neuron lesion
 Hoffman’s sign
o Examiner holds patient’s middle finger and briskly flicks the distal phalanx
o If test is +, the interphalangeal joint of the thumb of the same hand flexes = upper motor
neuron lesion