Cervical Distraction Test: Difference between revisions

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'''Original Editor '''- [[User:Nikki Arnold|Nikki Arnold]]  
'''Original Editor '''- [[User:Nikki Arnold|Nikki Arnold]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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== Purpose<br>  ==


Provocative Diagnostic Test for the presence of cervical radiculopathy.<ref name="Users' guide">Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in Motion:2008.</ref>&nbsp;<ref name="Malange et al">Malange GA,Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205</ref><br>  
== Purpose  ==
 
Provocative Diagnostic Test for the presence of cervical radiculopathy.<ref name="Users' guide">Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in Motion:2008.</ref><ref name="Malange et al">Malange GA,Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205</ref>  


== Test Position  ==
== Test Position  ==


Supine or sitting upright&nbsp;<ref name="hop" />  
Supine or sitting upright<ref name="hop" />  


== Technique<br> ==
== Technique  ==


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Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's either by placing each hand around the patient’s mastoid processes, while standing at their head, or place one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force&nbsp;<ref name="Wainner and Gill" />  
Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's either by placing each hand around the patient’s mastoid processes, while standing at their head, or place one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force<ref name="Wainner and Gill" />  


A positive test is the reduction or elimination of symptoms with traction .<ref name="Wainner and Gill">Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT.2000 Dec;30(12):728-744.</ref>  
A positive test is the reduction or elimination of symptoms with traction .<ref name="Wainner and Gill">Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT.2000 Dec;30(12):728-744.</ref>  
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== Tissues being tested  ==
== Tissues being tested  ==


Neural foramen and joint capsules around the facet joints of the cervical spine. The neck extensor muscles are also secondarily observed during this test.<ref name="hop">Hoppenfeld, Stanley. Physical Examination of the Spine &amp;amp;amp;amp;amp; Extremities. Pg 126- 127.</ref>  
Neural foramen and joint capsules around the facet joints of the cervical spine. The neck extensor muscles are also secondarily observed during this test.<ref name="hop">Hoppenfeld, Stanley. Physical Examination of the Spine &amp; Extremities. Pg 126- 127.</ref>  


== Positive Test  ==
== Positive Test  ==


If pain is relieved as a result of the movement, then the test is positive for nerve root compression and facet joint pressure. Determining the grade of the pressure would be decided by the amount of pressure and pain relieved while performing the test.&nbsp;<ref name="hop" />  
If pain is relieved as a result of the movement, then the test is positive for nerve root compression and facet joint pressure. Determining the grade of the pressure would be decided by the amount of pressure and pain relieved while performing the test.<ref name="hop" />  


== Common Errors  ==
== Common Errors  ==


Common errors by the examiner would include improper position of the examiner, and or improper position of the examiners hands. Common errors by the patient include slumping (not sitting up straight), and not relaxing the muscles of the neck and spine which can result in an altered outcome of the test.&nbsp;<ref name="hop" />  
Common errors by the examiner would include improper position of the examiner, and or improper position of the examiners hands. Common errors by the patient include slumping (not sitting up straight), and not relaxing the muscles of the neck and spine which can result in an altered outcome of the test.<ref name="hop" />  


== Importance of Test  ==
== Importance of Test  ==
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The test item cluster included:  
The test item cluster included:  


*(+) ULTT (median)  
*Positive ULTT (median)  
*Involved cervical rotation less than 60 degrees  
*Involved cervical rotation less than 60 degrees  
*(+) Spurlings test
*Positive Spurlings test
 
*Positive distraction test
'''&nbsp;(+) Distraction test(+) LR of 30.3 if all 4 tests are positive.''' <ref name="Wainner et al" />
 
== Related Tests<br>  ==
 
[[Spurlings Test]]&nbsp;:&nbsp;superior to the distraction test in that it would be more specific to the exact side or portion of the cervical spine that is affected


Cervical Compression Test&nbsp;:&nbsp; equal to the cervical distraction test as it is testing for the same tissues, but instead of relieving pain, the movement reproduces pain&nbsp;<ref>http://at.uwa.edu/special%20tests/specialtests/upperbody/Distraction.htm</ref>  
'''LR+ of 30.3 if all 4 tests are positive.'''<ref name="Wainner et al" />  


== Evidence<br> ==
== Related Tests ==


[[Test Diagnostics|Sensitivity]]&nbsp;&nbsp;0.44
*[[Spurlings Test]]: superior to the distraction test in that it would be more specific to the exact side or portion of the cervical spine that is affected
*Cervical Compression Test: equal to the cervical distraction test as it is testing for the same tissues, but instead of relieving pain, the movement reproduces pain<ref>http://at.uwa.edu/special%20tests/specialtests/upperbody/Distraction.htm</ref>


[[Test Diagnostics|Specificity]]&nbsp; 0.97<ref name="Rubinstein et al">Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J.2007;16:307-319.</ref>
== Evidence  ==


Reliability &nbsp; 0.88<ref name="Wainner et al">Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.</ref><br>  
*[[Test Diagnostics|Sensitivity]]: 0.44
*[[Test Diagnostics|Specificity]]: 0.97<ref name="Rubinstein et al">Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J.2007;16:307-319.</ref>
*Reliability: 0.88<ref name="Wainner et al">Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.</ref>  


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1NqsX9BbHlDlgR7udgNqDhlQmEeZUgyaGQNSWrL_cDi55tOs3r|charset=UTF-8|short|max=10</rss>  
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== References  ==
== References  ==
References will automatically be added here, see [[Adding References|adding references tutorial]].


<references />  
<references />  


[[Category:Cervical]][[Category:Cervical_Examination]][[Category:Videos]][[Category:Thoracic]][[Category:Special_Tests]][[Category:EIM_Residency_Project]][[Category:Clinical_Guidelines]][[Category:Assessment]][[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Cervical Spine]] [[Category:Cervical_Examination]] [[Category:Thoracic Spine]] [[Category:Assessment]] [[Category:Special_Tests]] [[Category:Clinical_Guidelines]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:EIM_Residency_Project]]

Revision as of 07:48, 3 October 2016

Original Editor - Nikki Arnold

Top Contributors - Admin, Venus Pagare, Nikki Arnold, Kim Jackson, Alyssa Brooks-Wells, Laura Ritchie, Evan Thomas, Naomi O'Reilly, Kai A. Sigel, WikiSysop, Rachael Lowe, Tony Lowe, Melissa Billy and Dan Rhon

Purpose[edit | edit source]

Provocative Diagnostic Test for the presence of cervical radiculopathy.[1][2]

Test Position[edit | edit source]

Supine or sitting upright[3]

Technique[edit | edit source]

[4]

Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's either by placing each hand around the patient’s mastoid processes, while standing at their head, or place one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force[5]

A positive test is the reduction or elimination of symptoms with traction .[5]

Tissues being tested[edit | edit source]

Neural foramen and joint capsules around the facet joints of the cervical spine. The neck extensor muscles are also secondarily observed during this test.[3]

Positive Test[edit | edit source]

If pain is relieved as a result of the movement, then the test is positive for nerve root compression and facet joint pressure. Determining the grade of the pressure would be decided by the amount of pressure and pain relieved while performing the test.[3]

Common Errors[edit | edit source]

Common errors by the examiner would include improper position of the examiner, and or improper position of the examiners hands. Common errors by the patient include slumping (not sitting up straight), and not relaxing the muscles of the neck and spine which can result in an altered outcome of the test.[3]

Importance of Test[edit | edit source]

As disc height decreases and bone spurs accumulate, the space for nerves to enter and exit the vertebral canal gets smaller. The decreased space can result in greater pressure on the nerve roots or other innervated structures, causing pain and weakness. With distraction, the joint space is increased to relieve the pressure on the nerve roots, thus decreasing the symptoms.

Also, this test has been utilized in a cluster of special tests to more accurately identify cervical radiculopathy with a “clinical prediction rule”. According to Wainner et al. in 2003:

The test item cluster included:

  • Positive ULTT (median)
  • Involved cervical rotation less than 60 degrees
  • Positive Spurlings test
  • Positive distraction test

LR+ of 30.3 if all 4 tests are positive.[6]

Related Tests[edit | edit source]

  • Spurlings Test: superior to the distraction test in that it would be more specific to the exact side or portion of the cervical spine that is affected
  • Cervical Compression Test: equal to the cervical distraction test as it is testing for the same tissues, but instead of relieving pain, the movement reproduces pain[7]

Evidence[edit | edit source]

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. ↑ Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in Motion:2008.
  2. ↑ Malange GA,Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205
  3. ↑ 3.0 3.1 3.2 3.3 Hoppenfeld, Stanley. Physical Examination of the Spine & Extremities. Pg 126- 127.
  4. ↑ CR Technologies. Cervical Distraction Test. Available from: http://www.youtube.com/watch?v=xDX_TUesdh0[last accessed 09/03/13]
  5. ↑ 5.0 5.1 Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT.2000 Dec;30(12):728-744.
  6. ↑ 6.0 6.1 Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
  7. ↑ http://at.uwa.edu/special%20tests/specialtests/upperbody/Distraction.htm
  8. ↑ Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J.2007;16:307-319.
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