Term
| Ask the seated patient to place the palm of the affected extremity flat on the top of the head. If this action reduces or relieves the pain = nerve root compression or irritation due to IVF encroachment |
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Definition
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| Passively raise the patient’s shoulders by abducting the arms. The patient’s elbows are extended at this point and the shoulders are externally rotated [the palms are facing upwards]. The doctor supports the arms while the patient flexes the elbow. If this action causes pain = irritation of the roots of the brachial plexus. If there is no pain, then it is unlikely that the problem is a radiculopathy involving the roots of the brachial plexus. |
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Definition
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| Passively flex the neck of the supine patient towards the chest. If the patient’s hips and knees flex in response to this action = meningitis. |
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Term
| The seated patient’s head and neck are in the neutral position. The doctor then distracts the neck by exerting upward pressure on the occiput and chin. If distraction reduces the pain = nerve root compression or facet joint pathology. If distraction increases the pain = strain/sprain. |
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Definition
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Term
| Ask the seated patient to cough, sneeze and to strain. If any of these actions cause the pain to increases = space-occupying lesion. |
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Definition
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| Hold the middle finger of the patient proximal to the distal interphalangeal joint. The doctor then nips the fingernail of the middle finger of the patient between the thumb and index finger or flicks the middle finger with the fingernail of the doctor. If this action causes adduction of the thumb and slight flexion of the fingers = upper motor neuron lesion is present in upper limb. |
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Definition
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| Ask the seated patient to slightly extend and rotate the head to the affected side. Place your clasped hands on the top of the patient’s head and exerts downward pressure. If this action exacerbates the pain = nerve root compression by a space-occupying lesion or a subluxation. |
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Definition
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Term
| Attempt to completely extend the partly flexed knee of the supine patient. If this action causes pain [or may cause the other knee to flex involuntarily] = meningeal irritation as would be seen in meningitis. |
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Definition
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Term
| Ask the supine patient to flex the neck. If this action causes a sharp or electrical-type of sensation in the midline and occasionally into the extremities = multiple sclerosis, ALS or cervical myelopathy. |
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Definition
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Term
| Instruct the seated patient to rotate the neck to the shoulder and then extend the head to the affected side. If there is no pain, then ask the patient to flex the neck while still in rotation. Perform the test bilaterally. If this action causes pain radiating into the affected arm = nerve root compression or facet involvement. If there is pain on the opposite side = muscular strain. |
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Definition
| Maximum cervical compression |
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Term
| Ask the seated patient to attempt to flex, extend, laterally bend and rotate the neck while the doctor resists the movement. The doctor then moves the patient’s neck through the same movements passively. If there is pain during resisted movement = muscle strain. If there is pain during passive movement = ligamentous sprain. |
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Definition
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| Look to see if the seated patient is holding up his head gingerly in both hands. If the patient is supporting his head in both hands = cervical fracture or a severe sprain. |
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Definition
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Term
| Push down on the shoulder of the affected side of the seated patient while laterally flexing the neck to the opposite shoulder. If this action exacerbates the pain on the depressed side = adhesions to either the dural sleeve or the spinal nerve roots or the adjacent structures in the joint capsule of the shoulder on the same side. |
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Definition
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Term
| Place one hand on the sternum of the supine patient to prevent any thoracic or lumbar flexion. The doctor then places the other hand under the patient’s occiput and passively flexes the patient’s neck slowly towards the chest. If this action causes localized pain in the posterior of the neck = vertebral fracture, ligamentous sprain, meningeal irritation or a subluxation. |
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Definition
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Term
| The seated patient’s head and neck are in the neutral position. The doctor places his hands on the top of the patient’s head and pushes down. The patient is then asked to rotate and flex the head to the affected side. The doctor should warn the patient about the next step. [“I will be tapping you on the top of your head. This might cause some pain. Is that OK with you?”] The doctor delivers a vertical blow to the top of the patient’s head. If this action exacerbates the pain = nerve root irritation caused either by cervical spondylosis or disc herniation. |
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Definition
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Term
| Ask the seated patient to hold their breath and bear down as if trying to have a bowel movement. If this action exacerbates the pain in the neck and upper limb = nerve root irritation caused by a space-occupying lesion in the cervical spinal canal such as a herniated disc, intraspinal tumor or a large osteophyte. |
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Definition
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