Special tests of the cervical Spine instability

Diagnostic tests of the cervical spine injury:

Special tests of the cervical Spine instability in Physiotherapy are given below:

  • Vertebral artery test
  • Hautant’s test
  • Spurling’s test
  • Distraction test
  • Shoulder abduction test
  • Upper limb tension test

1. Vertebral artery test:

Aim of the test:
Identifies the integrity of vertebrobasilar artery (vertebrobasilar insufficiency) 
Patient position:
Patient is supine; the examiner takes the patient head & neck into extension, right & left rotation, & side bending. Hold each position 10-30 sec unless symptoms are evoked. 
Positive sign:
dizziness, visual disturbances, disorientation, blurred speech, nausea, vomiting, etc.

2. Hautant’s test:


Aim of the test:
Differentiates vascular versus vestibular causes of dizziness/vertigo. 
Patient position:
Two steps to this test. a) Patient sitting with shoulders at 90° flexion & palms up. Have patient close their eyes and remain in this position for 30 sec. b) Patient sitting with shoulders at 90° flexion & palms up. 

3. Foraminal compression (Spurling’s) test:


Aim of the test:
Identifies dysfunction (typically compression) of cervical nerve root. 
Patient position:
This test is performed in 3 stages; if symptoms are produced, don’t proceed to next stage. First stage involves compression with the head in neutral, second in extension, third in extension & rotation to unaffected side then to affected side.
Positive sign:
Positive finding is pain and/or paresthesia in dermatomal pattern for involved nerve root.

4. Distraction test:

Aim of the test:
Indicates compression of neural structures at the intervertebral foramen or facet joint dysfunction. 
Patient position:
Patient sitting or supine, examiner places one hand under patient’s chin & other hand around the occiput and the head is passively distracted. 
Positive sign:
Positive finding is a decrease in symptoms in neck (facet condition) or a decrease in upper limb pain (neurologic condition).

5. Shoulder abduction test (Bakody’s sign)

Aim of the test:
Indicates compression of neural structures within intervertebral foramen. 
Patient position:
Patient sitting and asked to place one hand on top of their head. Repeat with opposite hand. 
Positive sign:
Positive finding is a decrease in symptoms into upper limb. If increases, it implies increase pressure in the inter scalene triangle. 

6. Upper limb tension tests (ULTT):

ULTT are equivalent to SLR test in lumbar spine. Tension tests designed to put stress on the neurological structures of UL, on all tissues of UL. Modification of the position of shoulder, elbow, wrist & fingers places greater stress on special nerves (nerve bias). The final movement is sometimes referred to as sensitizing test (e.g., neck side flexion in ULTT). 
Aim of the test:
Evaluation of peripheral nerve compression. 


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