Special Tests in The Spine
Tara Jo Manal PT,OCS, SCS
University of Delaware
Vertebral Artery Test
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Combined Movements
to stress test the
cervical spine
Symptoms:
–
–
–
–
–
Dizziness -Tinnitus
Lightheadedness
Nystagmus -Parathesia
Dysarthria - Diplopia
Dysphagia
University of Delaware
Vertebral Artery Preliminary Test
Patient is sitting. Sustain cervical extension
for 10 seconds.
 Sustain Rotation (L and R) 10 seconds
 IF POSITIVE STOP
 If the testing is negative progress to
standard position.

University of Delaware
Vertebral Artery Standard Test
Patient is supine. Sustain cervical extension
for 10 seconds.
 Sustain Rotation (L and R) for 10 seconds
 Combine Extension with Rotation (L and R)
for 10 seconds.
 Test the patient in the manipulation
position
 IF POSITIVE STOP, do not manipulate

University of Delaware
Cervical Distraction

Nerve Root
Compression

Radicular pain is
decreased, test is
positive
University of Delaware
Cervical Compression Test

Pressure downward on
head

Test is positive if pain
is evoked
University of Delaware
Spurling A
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Seated
Neck Side bent to the
ipisilateral side
7kg of overpressure
applied
Presence of pain,
parasthesial or
numbness
University of Delaware
Spurling B

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Seated
Extension
Sidebending and
Rotation to the
ipsilateral side
7kg of axial pressure
is applied
University of Delaware
Sharp –Purser Test
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Neck in semi flexion
Palm of one hand on
forehead
Index finger on
Spinous process C2
Posterior force
through forehead
Posterior slide is + for
AA instability
University of Delaware
Shoulder Abduction Sign


Most common nerve
root compression at
C5-6
Decrease in symptoms
is positive response
University of Delaware
Median Nerve Testing
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Shoulder Retraction
and Depression
Shoulder Extension
External Rotation
Elbow Extension
Forearm Supination
Wrist/Finger
Extension
Cervical SB and Rot
Away
University of Delaware
Upper Limb Tension Testing A
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Scapular Depression
Shoulder Abduction
Shoulder ER
Elbow Extension
Forearm Sup
Wrist and Finger
Extension
University of Delaware
Radial Nerve Testing
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Proximal as for
Median
Shoulder Internal Rot
Forearm Pronation
Wrist Flexion
Ulnar Deviation
Finger Flexion
University of Delaware
Upper Limb Tension Testing B

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Supine in 30º Abd
Scap Depression
Shoulder IR
Elbow Extension
Wrist and Finger
Flexion
Opposite Cervical SB
and Rot
University of Delaware
Ulnar Nerve Testing
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Shoulder Retraction
Shld Ext and ER
Elbow Flexion
Forearm Supination
Wrist Extension and
Radial Deviation
Finger Extension
Cervical SB and Rot
away
University of Delaware
T1 Nerve Root Stretch
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Abduct to 90º
Flex pronated arms to
90º
Flex elbows and place
behind the neck
Pain in scapular area is
T1- Pain in Ulnar
distribution is Ulnar
University of Delaware
Cervical Lateral Glides
University of Delaware
University of Delaware
University of Delaware
Intervention

3 Thrust
Manipulations
– 2 reps of each

Seated Distraction
University of Delaware
Intervention

Supine Upper
Thoracic Manip
University of Delaware
Intervention

Supine Middle
Thoracic Manipulation
University of Delaware
Other Intervention

Cervical ROM
University of Delaware
Upper Thoracic Manipulation
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CT junction
Patient sits far back on
table
Stabilize shoulders
Use their hands as
fulcrum
Distract upwards
– Drop down
University of Delaware
Winters, et al., 1997

Manipulation to
surrounding structures in
patients with complaints
originating from the
shoulder girdle are more
effective when the
shoulder pain is not
related to decreased ROM
in the glenohumeral joint
University of Delaware