Complete the table below
NAME OF ORTHOPAEDIC TEST
Cervical Axial Compression (4th provocative
– then go through all the compression
tests)
Cervical distraction test (do last)
Cervical Flexion Compression test
Cervical Rotation Compression test
Cervical Lateral Flexion Compression test
Cervical Maximal Compression test
Shoulder Depression test (3rd provocative)
INTERPRETATION/WHAT TISSUE STRUCTURE DOES THIS TEST
LOAD?
With the head in neutral, a positive test would indicate an upper
cervical lesion.
A positive result is classified as positive if the pain is relieved or
decreased when the head is lifted or distracted. It is indicative of
pressure on nerve roots that has been relieved by opening of the
IVF. Disc protrusion and degeneration pain would be relieved. A
positive test would also be if local pain increased, this would
indicate muscle/ligament strain.
When this test is performed with the patient’s head in flexion, a
positive test would most likely indicate an intervertebral disc
lesion as flexion puts tissue load on the anterior disc.
The test is positive if, on testing, pain radiates into the arm. This
indicates pressure on a nerve root. The pain distribution can give
some indication of which nerve root is affected.
A test result is classified as positive if the symptoms in the arm
are reproduced when the head is flexed toward the side of
compression. This indicates pressure on a nerve root as the IVF is
closed down on the side of lateral flexion. The distribution of pain
altered sensation can give indication as to which nerve root is
involved.
A positive test is indicated if pain radiates into the arm. If the
head is taken onto extension, the IVF closes maximally and
symptoms will be accentuated. Pain along the arm could indicate
radiculopathy or IVF encroachment.
Local neck pain could indicate sprain or strain along the area
being stretched.
If pain increases during lateral flexion, it indicates irritation or
compression of the nerve roots, foramina encroachments such as
osteophytes: if the pain in the area, or adhesions around the
dural sleeves of the nerve and adjacent joint capsule of the side

Shoulder abduction test (Bakody’s) (2nd
least provocative)
Valsalva test (least provocative)
Lhermittes sign (Chiro’s don’t treat this-
send patient to the hospital)
Other symptoms of meningeal irritation
 Photophobic
 Fever
Brachial plexus tension test
Adson’s test
(Thoracic outlet syndrome is trunk
irritation, Brachial plexus, is compressed)
Trunk has overlap of nerve roots so can be
a vaguer sense of pain. Majority of these
issues are more on ulnar side (C8, T1)
distribution because of the distribution of
the brachial plexus)
being stretched.
This procedure stretches the brachial plexus and nerve roots. If
the arm pain is increased on the side of neck side flexion it
suggests radicular irritation.
This test may provoke local neck pain due to stretching in
muscular, ligamentous or capsular tissues (on the side being
stretched).
This test shortens the brachial plexus and takes the pressure off
it. A decrease or relief of symptoms indicates a cervical
extradural compression, usually in the C5-C6 area
A positive test is indicated by increased pain, which may be due
to increased intrathecal pressure. This increased pressure within
the spinal cord is usually due to a space-occupying lesion, such as
a herniated disc, a tumour or osteophytes
A positive test is indicated by a sharp pain down the spine and
into the upper and lower limbs. It is indicative of dural or
meningeal irritation to the spine.
Lhermitte’s sign rarely occurs except in:
 Subacute combined degeneration of the cord
 Neck trauma
 Radiation myelitis
 Prolapsed cervical disc
The clinician presses gently deep into the lateral neck tissues in
the region of the intervertebral foramina. A reproduction or
increase of arm pain with pressure over the area of the nerve
roots (T1, T2) suggests nerve root irritation, local tissue damage
or sprain/strain.
If this test causes a reproduction in the patient’s symptoms with a
disappearance of the radial pulse, the test is positive for thoracic
outlet syndrome. The scalene triangle muscles, (in particular, the
anterior scalene) is likely to be responsible)
Halstead test (reverse Adson’s)
Wright’s test (hyperabduction)
Costoclavicular test
Provocation elevation test (Roos)
Slump Test
Passive Scapular Approximation
Percussion
If this test causes a reproduction in the patient’s symptoms with a
disappearance of the radial pulse, the test is positive for thoracic
outlet syndrome. The scalene triangle muscles, (in particular, the
posterior scalene) is likely to be responsible)
If this test causes a reproduction in the patient’s symptoms with a
disappearance of the radial pulse, the test is positive for thoracic
outlet syndrome. The pectoralis minor muscle is likely to be
responsible)
If this test causes a reproduction in the patient’s symptoms with a
disappearance of the radial pulse, the test is positive for thoracic
outlet syndrome. A decreased costoclavicular space may be
responsible for patient symptoms. This test is particularly
effective in patients who complain or symptoms while in patients
who complain of symptoms while wearing a back back or heavy
coat.
If fatigue, cramping, or tingling occurs during the test, the test is
positive for vascular insufficiency and thoracic outlet syndrome.
If the patient is unable to fully extend the knee because of pain,
the examiner releases pressure on the cervical spine and the
patient actively extends the neck. If the knee extends further and
the symptoms decrease with neck extension, then the test is
considered positive for increased tension in the neuromeningeal
tract.
The examiner passively approximates the scapulae by lifting the
shoulders up and back.
Pain in the scapular area is indicative of a T1 or T2 nerve root
problem on the side where the pain is being experienced.
Pain that patients fell during this procedure is secondary to the
stretching of a damaged serratus anterior muscle or
scapulocostal syndrome.
Percussion of spinous processes and ribs for pain, which may
suggest fracture of bone disease/ If a rib fracture is suspected,
percuss the affected rib away from the site of pain and if the pain
is reproduced.
Rib Fracture Screen
Adam’s Forward Bending Test
Ott Sign
Chest Expansion
Beevor’sSign
Abdominal Reflexes
Rib fracture gives focal/ pinpoint pain
During forward flexion AROM, look for any asymmetry of the
chest wall, inequality of the scapulae and differences in the levels
of the shoulders. A useful sign of scoliosis is unequal shoulder
levels and apparent ‘winging’ of the scapular. Inspection should
take place with posterior, lateral and anterior views. If the
scoliosis and any associated rib hump disappear on flexion, the
scoliosis is function; if they remain the scoliosis Is structural.
With the patient standing, the examiner marks the C7 spinous
process and a point 30cm inferior to it. This distance should
increase by 2-4cm in flexion and decrease by 1-2cm in extension.
Degenerative inflammatory processes of the spine restrict spinal
mobility and range of motion.
The patient is seated. The examiner places a tape measure
around the patient’s chest at the T4 level. The patient fully
exhales and the measure is taken. The patient then fully inhales
and a second measurement is taken and the difference between
the two measurements is noted.
In the normal adult male, the difference will be >5cm and for
females >3.5cm. A decreased measurement may indicate
ankylosing condition such as ankylosing spondylitis.
This is a sign of functional paralysis consisting of inability of the
patient to inhibit the antagonistic muscles. Ask the patient to lift
their head and shoulders slightly from the bench. Upward
deviation of the umbilicus on attempting this (caused by a
contraction of the upper but not lower abdominal muscles), may
be indicative of a spinal cord lesion in the region of the lower
thoracic vertebrae. The umbilicus should normally stay relatively
still.
The skin of each quadrant is stimulated by quickly dragging the
sharp end of the reflex hammer across it.
Normally stimulation should cause the abdominal muscles to
involuntarily contract, resulting in movement of the umbilicus in
the direction of the quadrant being stimulated.
The reflex can be absent due to obesity, previous surgery, in the
multiparous female and with increasing age.

Pathological absence of the normal response suggests thoracic

spinal cord compression of the diminished reflex.

Remembering that the upper abdominal muscles are innervated

by T7 through T10 nerve roots and the lower abdominal
musculature is innervated by T10 through L2 nerve roots helps
the examiner identify the approximate level of involvement.