Examination
Examination
 History – General
 General Demographics
Age
 Sex
 Race/ethnicity
 Primary language
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Social History
Cultural beliefs and behaviors
 Family and caregiver resources
 Social interactions, social activities and support systems
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Occupation/employment: overuse, trauma, sitting…
Examination
 History (contin)
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Growth and Development
Hand dominance
 Developmental history
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Living Environment
History of Current Condition
Reason for coming to PT
 Current therapeutic interventions
 Mechanism of injury or disease including date of onset & course of
events: MVA
 Onset and pattern of symptoms: acute event
 Patient/client, family, significant other, and caregivers perception of
patient’s current status
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Examination
 History (contin)
 Medications
Meds for current condition
 Meds for other condition(s)
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Other tests and measures
Lab and diagnostic tests
 Review available records
 Review nutrition and hydration
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Past History of Current Condition
Prior therapeutic interventions (manipulation)
 Prior meds
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Examination
 Past Medical/Surgical History
 Endocrine/metabolic
 Cardiopulmonary
 G-I
 G-U
 Integumentary
 MS
 NM
 Pregnancy, delivery and post-partum
 Prior hospitalizations, surgeries, pre-existing medical and
other conditions
Examination
 Family History
 Health Status
 General health perception
 Physical function
 Psychological function
 Role function
 Social function
 Social Habits
 Behavioral health risks
 Level of physical fitness
 Specific History
 Headaches (c-spine, AA, vestibular)
 Dizziness
 Pillow at night
Examination
 Systems Review:
 Cardiovascular/pulmonary (HR, RR, BP, edema)
 Integumentary (skin integrity, skin color, scarring)
 MSK (UQS)
 Neuromuscular (balance, locomotion, transfers)
 Communication ability (affect, cognition, language & learning
style, orientation, etc…)
Examination
 Tests and Measures
 Inspection
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Size/Shape/Deformity
 Posture
 Atrophy
 Swelling
 Deformities (scoliosis, kyphosis)
 Bracing
 Scapular symmetry
 Ability to disrobe
 Bony landmark symmetry
Examination
 Tests and Measures
 Inspection
Color
 Temperature
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ROM
AROM
 Observe for opening or closing restriction
 Rotation, flexion, extension, SB, combined mvts, sustained
positions, repeated mvts
 PROM
 Measurements (bubble)
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Examination
 Tests and Measures
 Flexibility
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Upper trap
Scalenes
Levator
Pectoralis minor
Strength Assessment
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MMT
 Deep flexors (endurance test)
• Supine- chin tuck (craniovertebral flexion and lower cx flexion) occiput approx 1
inch above table- 3 trials then test
• Norms: males (40 +/-20) and females (30 +/- 14) sec’s
• Reliability: 0.67 without pain and 0.87 with pain (Harris, Harris, and Olsen)
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Neck extensors
Neck rotators
Lateral flexors
Examination
 Tests and Measures
 Upper Cervical Stability Tests
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Sharp’s Purser (transverse ligament)
 Pt seated, cx flexed (comfortable), examiner places palm of one hand on
pt’s forehead and the index finger of free hand on C2. Examiner pushes
post on pt’s forehead. + test = reduction in sx’s, clunk or click may be felt in
the roof of the mouth = reduction.
 Sen 69%, spec 96% laxity > 3mm, +LR 17.3, - LR 0.32; if laxity > 4mm sen
to 88% (Uitvlugt and Indenbaum 1988); RA AA most signif complication
20-70% (Kauppi M et al 1998)
Alar ligament
 Clinical Utility (not known)
• Pt supine, the PT grips and stabilizes C2 sp process; then C1 is SB on two; - test
very little mvt; + test lag in C2 mvt; test repeated with C1 rot
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Anterior Shear Test (transverse ligt test)
 Clinical Utility (not known)
• Pt supine, PT support head, C1 and occiput sheared anteriorly. + test sensation of
lump in throat or the presence of cardinal signs
Examination
 Tests and Measures
 Mobility
P-A glides
 Sidegliding
 AA rotation
 OA Flex/Ext
 Smedmark et al (2000) 77% agreement for all tests using
PPIVM
 Jull et al (1988) PPIVM- accurately identified symptomatic
joints in 15 pt’s
 First rib spring testing
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Examination
 Tests and Measures
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Special tests
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Vertebral artery test: sustained ext and rotation each side
 (Cote et al 1996) Post predictive value is 0% (portion of pop with + test who are correctly
diagnosed = 0)
Hoffman’s test
 Tapping of flicking the nail of the distal phalanx of 3rd or 4th finger; + test flex terminal
phalanx of thumb; for cord comp sen = 58%, spec = 78% (Glaser JA et al 2001)
Spurling- 30° SB, 30° SB with compression (radiculopathy)
 Sen .50, spec .88, -LR .58, +LR 3.5 (Rubinstein SM et al 2007, Shah KC et al 2004)
Cervical distraction
TOS
 Provocative tests: sen 72% and spec 53% (Adson maneuver and Wright test); cluster
findings improves spec
 Adson- pt sit arms on thighs, PT palpate radial pulse, deep breathe, hyperext cx and SB
 Wright test- pt sitting, arm in up and back into hyperabduction (palpate pulse)
Flexion rotation (FRT)- full flexion and rotation (ave 44°); sen 90%, spec 88%, in experienced
PT’s for cx headaches (ave ROM loss 17°) Hall et al 2008, Ogince M et al 2007
Sensory examination
Dermatome UE
Examination
 Tests and Measures
 Palpation (spinous processes, transverse, mastoid, thyroid
cartilage, sternum, clavicle, scapula, carotid artery, occipital
bone, 1st rib position)
References
 Rubinstein SM et al., A systematic review of the diagnostic accuracy of provocative
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tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007:16:307319.
Shah KC et al., Reliability of diagnosis of soft cervical disc prolapse using Spuling’s
test. British Journal of Neurosurgery. 2004:18(5):480-483.
Glaser JA et al., Cervical Spinal Cord Compression and the Hoffman Sign. Iowa
Orthop J. 2001:21:49-52.
Treleaven J et al., Sensorimotor disturbances in neck disorders affecting postural
stability, head and eye movement control. Manual Therapy, 2008:13;2-11.
Petty NJ and Moore AP. Neuromuscular Examination and Assessment (second
edition) 2001: Elsevier.
Uitvlugt G and Indenbaum S. Arthritis and Rheumatism 1998:31(7):918-922.
Kauppi M et al., Active conservative treatment of atlantioaxial subluxation in
rheumatoid arthritis. British J Rhem. 1998:37:417-420.
Hall TM et al., Intertester Reliability and Diagnostic Validity of the Cervical FlexionRotation Test. J Manipulative Physiol ther.2008;31:293-300.
Ogince M et al., The diagnostic validity of the cervical flexion-rotation test in C1/2
related cervicogenic headache. Man Ther2007;12:256-262.