SPECIAL TESTS FOR

CERVICAL RADICULOPATHY
1.FLEXION COMPRESSION TEST:

Procedure:
• The patient is seated .
• The examiner stands behind the patient and passively moves the cervical spine into
flexion (tilts the patient’s head forward).Then axial compression is applied to the top of
the head.
ASSESSMENT:
• This is a good test of the integrity of the intervertebral disk.
• In the presence of a posterolateral disk extrusion, this maneuver will press the extruded
portion pf the disk in a posterior direction, resulting in increasing compression of the
nerve root.
• An increase in radicular symptoms can therefore indicate the presence of posterolateral
disk extrusion.
Flexion Compression test:
2.EXTENSION COMPRESSION TEST:

Procedure:
• The patient is seated.
• The examiner stands behind the patient.
• The cervical spine is extended 30 degree.
• The examiner then applies axial compression to the top of the head.
Assessment:
• This test assesses the integrity of the intervertebral disk. Where an posterolateral
extrusion with an intact annulus fibrosis is present, shifting the pressure on the disks
anteriorly will reduce symptoms.
• Increased pain without radicular symptoms usually indicates an irritation in the facet
joints as a result of decreased mobility due to degenerative changes.
EXTENSION COMPRESSION TEST
3.SPURLING TEST:

• Assess facet joint pain and nerve root irritation.

Procedure:
• The patient is seated with the head rotated and tilted to one side.
• The examiner stands behind the patient with one hand placed on the
patient’s head.
• With the other hand,the examiner lightly taps (compresses) the hand
resting on the patient’s head.
• If the patient tolerates this initial step of test , it is then repeated with
the cervical spine extended as well.
Assessment:
• This test provides clinical evidence of both a facet syndrome and
nerve root compression.
• Where the facet joint irritation or nerve root compression is present,
the examination will intensify the pain.
• Simultaneous extension of the cervical spine narrows the
intervertebral foramina by 20-30%.
• Existing radicular pain will increase by this movement.
SPURLING TEST
4.SHOULDER DEPRESSION TEST:

• Assess the nerve root compression.

Procedure:
• Side flex patient’s head on unaffected side then apply a downward
pressure on the opposite shoulder (affected side).
• Positive sign – increase in pain.
• This test provides evidence for nerve root compression.
SHOULDER DEPRESSION TEST:
5. DISTRACTION TEST:
• Differentiates between radicular pain in the back of the neck, shoulder, and arm and ligamentous
or muscular pain in these regions.
Procedure:
• The patient is seated.
• The examiner grasps the patient’s head about the jaw and the back of the head and applies
superior axial traction.
Assessment:
• Distraction of the cervical spine reduces the load on the intervertebral disks and exiting nerve
roots within the affected levels or segments while producing a gliding motion in the facet joints.
• Reduction of radicular symptoms, even in passive rotation, when the cervical spine is distracted is
a sign of discogenic nerve root irritation.
• Increased pain during distraction and rotation suggests a functional impairment in the cervical
spine due to muscular or ligamentous pathology.
DISTRACTION TEST
THE UPPER LIMB TENSION TEST (ULTTs):

• Also known as Brachial plexus tension or elvey test.

• These tension test are performed to check the peripheral nerve compression,
specially for checking cervical radiculopathy.
Method:
• Each test is done on the normal/asymptomatic side first.
• Each joint positioning component is added until the pain is provoked or symptoms
are reproduced.
• To further sensitive the upper limb tests , side flexion of cervical spine can be
added.
• If pain is provoked in the very initial position, then there is no need to add further
sensitisers.
Positive test:
The test is positive if one or more of the following occurs:
• Symptoms reproduced
• Side to side difference in elbow extension greater than 10
degrees
• Contralateral cervical side bending increases symptoms,
or ipsilateral side flexion decreases symptoms.
Upper limb tension test -1 ( ULTT-1)

• Nerve bias: median nerve, anterior interosseous nerve, nerve root C5-C7
Procedure:
• Patient in supine lying.
• Therapist by the side of patient in walk stand position.
• Shoulder: abduction 110 degrees
• Elbow: flexion 90 degrees
• Shoulder: laterally rotation
• Wrist and finger: extension
• Elbow: extension
• Cervical: lateral flexion to contralateral side.
Upper limb tension test-2(ULTT-2)

• Nerve bias: median nerve, axillary nerve, musculocutaneous nerve

Procedure:
• Shoulder: depressed by therapist’s hip
• Arm : abduction 10 degrees
• Elbow: flexion 90 degrees
• Forearm: supinate
• Wrist and finger: extension
• Elbow: extension
• Cervical: lateral flexion to contralateral side.
Upper limb tension test-3 (ULTT-3)

• Nerve bias: Radial nerve

Procedure:
• Shoulder depressed by therapist’s hip.
• Arm: flexion 10 degrees
• Elbow: 90 degrees
• Forearm: pronation
• Finger and wrist: flexion
• Elbow: extension
• Cervical: lateral rotation contralaterally
Upper limb tension test-4 (ULTT-4)

• Nerve bias: ulnar nerve, nerve root C8- T1

Procedure:
• Shoulder: depression
• Arm: abduction 90 degrees
• Forearm: pronate
• Finger and wrist: extension
• Shoulder: lateral rotation
• Slowly bring fingers towards the ear.
• Cervical: lateral flexion contralaterally