Testing
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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
Testing
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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
o Do not perform until r/o cervical fracture or instability!
Testing
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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
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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
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Oppenheim
o Pt is supine
o Examiner runs a fingernail along the crest of the anteromedial tibia
o If test is +, the great toe extends and the other toes splay or hypersensitivity to the test =
upper motor neuron lesion
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Hoffman’s sign
Testing
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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