Jull/ Neck flexor Endurance Test

Introduction
• Jull’s test is a cervical spine examination procedure that tests for deep neck flexor muscle weakness
or deconditioning.
Procedure
• Patient should be in a supine lying position for this
procedure.
• The patients head is supported on a folded towel, and an
inflatable pressure sensor is positioned behind the neck
and below the occiput.
• The bladder is inflated between the neck and the table.
• The patient flexes the cervical spine by nodding the head
in five graded segments of increasing pressure
• The patient holds each segment for 10 seconds with a
10 second break between each segment
• Superficial cervical muscles must remain relaxed during the test
• The examiner will observe for chin jutting or excessive shaking.

Positive Jull’s Test

• A positive Jull’s Test is considered if the patient cannot increase to at least 26 mm Hg
• Is unable to hold a contraction for 10 seconds, uses superficial neck muscles, or extends the head
Brachial Plexus Compression Test : Doorbell Sign

Introduction
• Brachial Plexus Compression Test is used to differentiate between radicular pain as a result of nerve
root compression (or thoracic outlet Syndrome) and local cervical strain or sprain.
• Doorbell sign is a useful test to determine if cervical spine pain is due to local tissue injury or due to
an irritation in the nerve root.

Procedure
• The patient is seated
• Palpation needs to be gentle
• The examiner should be at the patient’s back and uses his fingers to tap over the brachial plexus
region.
• Examiner uses his/her fingertips to compress neurologic and muscular structures in the lateral aspect
of the neck observing for signs of pain or discomfort. (Doorbell sign)
• Examiner applies compressive force over the brachial plexus (squeeze brachial plexus between
fingers & thumb) for a duration of 10 seconds (Brachial Plexus Compression Test)

Positive Doorbell Sign when the following is seen

• Positive Local pain: Local tissue damage, sprain, strain.
• Positive Arm pain: Nerve root irritation or inflammation.

Positive Brachial Plexus Compression Test

• The test is positive only if the pain radiates into the shoulder or upper extremity reproducing the
patients radicular symptoms
• Radicular symptoms = Nerve root compression, thoracic outlet Syndrome, anterior scalene syndrome
• Local pain or discomfort = Cervical strain/sprain
Shoulder Depression Test

Introduction
• Shoulder Depression test is a cervical spine examination procedure that tests for radiculopathy, sprain or strain.
• The test is also used to evaluate the brachial plexus for lesions and to assess for plexopathies.

Procedure
• Patient is in sitting position for this procedure.
• The examiner laterally flexes the patients head away from the side that is being tested while applying
a downward pressure on the opposite shoulder.
• The examiner takes note of any localized pain or shoulder pain or arm pain as he presses on the
patient’s shoulder.

Positive Shoulder Depression Test

• If pain is reproduced, it indicates irritation or compression of the nerve roots, foraminal
encroachments such as osteophytes
• Pain on the arm along the tested area; this could indicate radiculopathy.
• Local pain; this could indicate sprain or strain in the area.
O’Donoghue Manoeuvre

Introduction
• O’Donoghue Maneuver is a cervical spine examination procedure that tests for cervical sprain.
• The test is done in two parts: one during resisted motion while another is during passive motion.
• Pain during resisted motion could be due to muscle strain while passive motion could be ligament sprain

Procedure
• Patient should be seated as the test is done.
• The examiner is at the patient’s back where he moves the cervical spine. First he uses bilateral
resisted motion then through passive bilateral rotation.
• The examiner takes note of any pain when the head is moved passively and resistively.

Positive O’Donoghue’s Maneuver

• Pain during resisted motion could indicate muscle strain.
• Pain during passive motion could indicate ligament sprain.
Cervical Axial Compression Test

Introduction
• The Cervical Axial Compression Test reduces the size of the intervertebral foramen, compresses vessels and
nerves.
• Cervical compression test is used to test for compression of cervical nerve roots and facet joint irritation
Procedure
• Patient seated
• Examiner gently applies axial downward pressure on patient’s head in 3 stages
• Examiner gently applies a soft pressure and watches for the patients radicular symptoms – IF NIL
• Examiner applies a medium pressure and watches for the patients radicular symptoms- IF NIL
• Examiner applies a slightly heavier pressure and watches for the patients radicular symptoms
• The patient’s head is then placed in the flexed position and the same procedure is performed.

Positive Cervical Axial Compression Test

• With the head in neutral, a positive test would indicate an upper cervical lesion.
• When this test is performed with the patient’s head in flexion, a positive test would most likely
indicate an intervertebral disc lesion.
• Increased local pain: Joint damage, facet lock, meniscoid entrapment or ligament strain.
• Increased peripheral pain: Increased pressure on nerve roots (IVF encroachment, radiculopathy)
Cervical Distraction Test

Introduction
• Cervical distraction test is useful in accessing facet joint integrity as well as nerve root compression
(radiculopathy) in the cervical spine.

Procedure
• Patient seated
• Examiner securely grasps the patient's either by placing each hand around the patient’s mastoid
processes
• Examiner gently applies a distraction force elevating the patient’s head axially.

Positive Cervical Distraction Test

• If pain is relieved as a result of the movement, then the test is positive for nerve root compression and
facet joint pressure.
• Positive Increased local pain: Muscle or ligament strain.
Cervical Side Bend Compression Test

Introduction
• The Cervical Side Bend Test is a cervical spine examination used as a screening procedure to
detect radiculopathy
• The examiner will bend your head toward the side of your body where you have symptoms, any Radicular
pain to the ipsilateral shoulder and arm suggests cervical nerve root irritation.

Procedure
• Patient seated
• The patient laterally flexes their head to the symptomatic side
• The examiner carefully presses straight down on the head.

Positive Cervical side bend compression test when the following is seen:
• If the symptoms in the arm are reproduced when the head is flexed towards the side of the
compression
• Increased peripheral pain; this could indicate pressure on nerve roots (IVF encroachment or
radiculopathy).
• The distribution of pain altered sensation can give some indication as to which nerve root is involved.
Jackson’s Compression Test

Introduction
• Jackson’s Compression Test is cervical spine examination procedure used to identify the presence of
cervical radiculopathy among patients with upper quadrant pain.
• This test is a modification of the foraminal compression test

Procedure
• Patient should be seated for the procedure.
• The patient rotates their head to the unaffected side as the examiner applies a downward pressure over
the head.
• The patient then rotates their head to the symptomatic side and the examiner applies a downward
pressure over the head.
• The examiner assesses the patient for any local or peripheral pain.

Positive Jackson Compression Test

• The test is positive if the patient has radiating pain down the arm on the corresponding dermatome
ipsilaterally.
• The findings should be used to confirm cervical radiculopathy/nerve compression, in conjunction with
other neurologic/manual tests.
• Increased localized pain; this could indicate joint damage, meniscoid entrapment or muscle pain.
• Increased peripheral pain; this could indicate pressure on nerve roots (IVF encroachment or
radiculopathy).
Foraminal Compression Test (aka Cervical Kemps Test)

(Start Position) (Test Position)

Introduction
• The Foraminal Compression Test (Kemps) is a cervical spine examination procedure that assesses
for radiculopathy, IVF encroachment and for sprain or strain along the neck area.
• The Foraminal Compression test may also compress the vertebral artery and cause VBI-type
symptoms such as dizziness, vertigo and nystagmus.

Procedure
• Patient is seated
• Patient side extends the head, and rotates it to the same side
• Examiner carefully presses down on head
• Test is repeated both sides

Positive Foraminal Compression test

• A positive Kemps test defined as a reproduction of the patient’s pain radiating into their arm and a
strong indicator that a facet syndrome is present
• Pain along the arm; this could indicate radiculopathy or IVF encroachment.
Foraminal Compression Test (aka Spurling’s)

Introduction
• The Foraminal Compression Test (Spurling’s) is performed if, in the history, the patient has
complained of nerve root symptoms, which at the time of examination are diminished or absent.
• This test is designed to provoke the symptoms

Procedure
. The test is done in three stages.
• Patient should be seated as the examiner applies downward pressure with the head in neutral position.
• Patient is seated as the examiner applies downward pressure with the head in mild extension.
• Patient is seated as the examiner applies downward pressure with the head in extension, rotation
toward the unaffected side first then the afflicted side.
• The examiner takes note of any pain along the arm and neck during all three stages.

Positive Foraminal Compression test

• The test is considered positive if pain radiates into the arm toward which the head is slide flexed
during compression
• This indicates pressure on a nerve root
Shoulder abduction test (Bakody’s)

Introduction
• Shoulder Abduction Test (Bakody’s Sign) is used to assess for cervical radiculopathy especially at the
levels of C4-C5 or C5-C6.

Procedure:
• Patient is sitting or lying down
• The shoulder abduction test is performed by asking the seated patient to place their hand on top of
their head.
• This can be done actively by the patient or passively by the examiner
• The test can be performed using the asymptomatic arm first to help establish a baseline finding for the
side assumed to be "normal."
• This would be followed by alternately placing the hand of the symptomatic side on top of the head.

Positive Bakody’s Sign

• A decrease in or relief of symptoms indicates a cervical extradural compression problem, such as a
herniated disc, epidural vein compression, or nerve root compression in the C4-C5 or C5- C6 area
Valsalva Test

Introduction
• Valsalva Manoeuvre is used to determine the effect of increased pressure on the spinal cord.

Procedure:
• Patient may be seated or standing.
• Patient is instructed to take a deep breath and hold while bearing down as if “straining at stool.”
• Examiner can gently apply a fist to the abdominal area as patient presses back.

Positive Valsalva Test

• 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..
Lhermitte’s Sign

Introduction
• L’hermitte’s sign is a cervical spine procedure that tests the spinal cord itself for the presence of cervical
myelopathy
Procedure
• Patient should be seated or supine during the procedure.
• The examiner passively flexes the head forward with the legs straight simultaneously using gentle pressure.
• The examiner checks for any pain while maintaining pressure over the back of the head.

Positive L’hermitte’s Sign

• There is a positive L’hermitte’s Sign when there is sharp pain characterized by pain shooting down the spine or
extremities.
• This sign could indicate the presence of cervical myelopathy: cord tumour, posterior column disease, meningeal
adhesions or irritation, multiple sclerosis, stenosis, stenosis or disc herniation
Kernig’s/ Brudzinki’s Test

Introduction

• Brudzinski's sign is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness
causes a patient's hips and knees to flex when the neck is flexed.
• Kernig's sign is one of the physically demonstrable symptoms of meningitis. Severe stiffness of the
hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
• The examination can also be used to reproduce radiculopathy in root compression, or nerve tension
(sciatic nerve).

Procedure

• Patient supine, examiner passively flexes patient’s head & neck onto the chest.
• Simultaneously the examiner flexes patient’s hip to 90° with knee flexed.
• Examiner then extends patient’s knee until pain is felt
• The patient then flexes the knee, and the pain will disappear.

Positive Kernig’s/ Brudzinki’s Sign

• Pain is a positive sign, and may indicate the meningeal irritation, nerve root involvement or dural
irritation.