Dynamic Chiropractic

Dynamic Chiropractic Facebook Twitter
Dynamic Chiropractic
Find
Advanced Search
Wellness Blog
Dynamic Chiropractic PracticeINSIGHTS
Current Graphic
Facebook
Dynamic Chiropractic – March 15, 2014, Vol. 32, Issue 06
Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic

The Many Faces of Cervical Compression

By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM

When evaluating the neck, there are any number of orthopedic tests to be considered. In my experience, most examiners just perform a simple Y-axis compression – commonly performed by having the patient tilt the head back slightly while the examiner applies downward pressure on the vertex – and then note if there is pain.

However, there are a number of other maneuvers that can be pursued and interpreted to give you a better understanding of the nature of the patient's complaints. I have seen these test names get used interchangeably, but they are unique and specific tests.

Cervical Foraminal Compression

Note the location of any discomfort with rotation of the head and return to neutral. Pain on the opposite side of rotation suggests muscular strain, while pain on the side of rotation suggests facet or nerve root involvement. Gently and gradually exert downward pressure to reproduce the pain. If pain is produced, then turn the head to that side and perform the maneuver again.

Reproduction of pain is indicative of foraminal encroachment. Radicular pain should direct a more thorough exam to the indicated neurologic level.

cervical compression - Copyright – Stock Photo / Register Mark Jackson's Compression

Again with the patient seated, have them rotate side to side and localize the complaint. Pain on the opposite side of rotation suggests muscular strain, while pain on the side of rotation suggests facet or nerve root involvement. Flex the head laterally (ear to the shoulder) and hold the position while exerting gentle pressure down on the head.

The test is positive if the localized pain radiates down the arm. Note the nerve level and examine accordingly.

Maximum Cervical Compression

Patient seated with head in neutral, actively rotates the head to the side of the complaint and then extends (lifts the chin up). Increased pain on that side indicates nerve root or facet involvement; pain on the other side suggests muscular strain. A variation of this test may involve the same movements, but require the patient to flex the head (look down) while rotating.

Spurling's Test

This test is a combination of some of the other maneuvers. Again, have the patient sit and rotate the head – localize the pain. Laterally flex the head and gently press down to reproduce the pain. From the laterally flexed position, extend the head as far back as the patient can tolerate – localized pain at this time suggests facet; radicular pain indicates nerve root. Return to neutral.

The well-known modification to this test is to then perform a quick, vertical blow down on top of the head – this impulse will fire off any pain generators, including disc disease and cervical spondylosis.

Certainly, there are other tests, signs and observations to be made in individual cases. The more information you have to confirm your findings, the more secure you are in your diagnosis and treatment protocol. Understanding and applying the different versions of cervical compression tests can only improve your examination findings and the specificity of your care. This extra documentation also can help make the difference if you must justify your diagnosis to an insurer or third party.

Take the extra few seconds to add these tests into your exam routine – they will serve you well.

Resources

  1. Evans RC. Illustrated Essentials in Orthopedic Physical Assessment MO: Mosby, 1994.
  2. Hoppenfeld S. Physical Examination of the Spine and Extremities. CA: Appleton & Lange, 1976.

Click here for more information about Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM.

Dynamic Chiropractic

Dynamic Chiropractic
Printer Friendly Email a Friend PDF RSS Feed
Share |
Dynamic Chiropractic
Dynamic Chiropractic
Join the conversation
Comments are encouraged, but you must follow our User Agreement
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.
comments powered by Disqus
Dynamic Chiropractic
Have you ever contacted a local employer about the possibility of directing their corporate wellness program?
Yes, contacted
Yes, directing
Thinking about it
No

Sign Up for Our Webinars
Receive Advanced Notice of Future Webinars

 


Generic Viagra Lowest Prices Pfizer Drugs Viagra No Prescription Order Viagra Online Viagra Non Prescription Deal Sale Prescription Viagra Uk Online Levitra Reviews Viagra Oysters In Australia Viagra Price Australia Cialis Pill Color Generic Viagra Canada Buy Cheap Viagra Viagra Katelaris P Viagra Australia Cheap Levitra Prescription Or Not Viagra Levitra Usual Dosage Buy Tadalafil Cialis Online Viagra And Daibetes Viagra Tablets Uk Viagra Online From Us Pharmacys Generic Money Viagra Cialis And Priligy Next Dat Delivery Generic Viagra Vigora 5000 Effect Viagra Drug Interactions Online Levitra Tablet Viagra Buy Online Levitra Drug Interaction Walgreen Viagra Per Pill Viagra Online Gr 4.26 Buy Cialis Lowest Price Viagra Online Cheap Mexico Viagra Buying Free Sale Viagra Cheap Kamagra Viagra Buy Generic Online Viagra Viagra Online Sales Brand Viagra For Get Viagra Without Prescription Viagra Side Effects Blood Pressure Cialis For Sale In Us Australia Viagra Online Cialis Cheap Visa Auk Cialis Sales Bravejournal Buy Levitra Member Levitra Buy Online Find Cheap Cialis Vardenafil 20 Mg Hcl