Orthopedic Exam / Special Tests for Physical Therapy: HEAD & NECK
Special Test: SPURLINGS TEST
Cervical Nerve/ Cervical Nerve Roots:
There are eight cervical nerves that branch off of the spinal cord and control different types of bodily and sensory activities. Each cervical nerve root is named based on the lower cervical vertebra that it runs between. As an example, the nerve root that runs between the second cervical vertebra and the third cervical vertebra in the neck is described as the C3 nerve root.
Cervical Facet Joint Irritation:
Facet joint disorders are a common cause of neck problems in patients. When the acute cervical facet joint inflammation is at its peak, the symptoms may closely imitate those of a herniated disc, a deep infection, a fracture, or a torn muscle of the spine. On the other hand, deep anterior neck problems may imitate cervical facet disorders, so a good differential diagnosis must rule out such things. Cervical spine arthritis as a source of facet degeneration and pain can also be involved and this possibility should be examined.
Cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year. Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding). Cervical facet joint problems may radiate pain locally or into the shoulders or upper back, and rarely radiate in the front or down an arm or into the fingers as a herniated disc might.
Special Test: Spurlings Test
- To test for: Compression of a cervical nerve root or facet joint irritation in the lower cervical spine.
Video Demo Instructions, Procedure, Positive Test:
Special Test: SPURLINGS TEST: Video Demo (Procedure below)
Special Test: Spurlings Test: PROCEDURE
• Patient is seated while the examiner stands behind the patient.
• Patient slowly extends, sidebends, and rotates the head to the affected side.
• Examiner carefully applies compression downward on the head of patient
Special Test: Spurlings Test: POSITIVE SIGN
- Radiating pain or other neurological signs in the same side arm (nerve root) and/ or pain local to the neck or shoulder (facet joint irritation).
Cervical Distraction (after performing Spurling’s Test)
Purpose: To relieve the pressure on the cervical nerve roots
• Patient is supine or seated.
• Patient’s head is in a neutral position at all times throughout the procedure.
• Therapist grasps the patient’s head at the occiput and temporalis, one hand on either side of the head.
• Slowly traction the patient’s head in a superior direction. Maintain the traction for at least 30 seconds.