Cervical Flexion-Rotation Test: Difference between revisions
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Smith et al. concluded that age did not significantly influence mobility during the FRT. One explination for this is that the upper cervical spine undergoes minimal age-related degenerative changes, in comparison to joints lower in the cervical spine. (Dvorak et al., 1992). Also lifestyle factors including sleep position, time spent sitting and side dominant lifestyle did not appear to influence variability in cervical mobility.<ref>Smith et al. The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion. Manual Therapy 2008;13:552-559</ref> | Smith et al. concluded that age did not significantly influence mobility during the FRT. One explination for this is that the upper cervical spine undergoes minimal age-related degenerative changes, in comparison to joints lower in the cervical spine. (Dvorak et al., 1992). Also lifestyle factors including sleep position, time spent sitting and side dominant lifestyle did not appear to influence variability in cervical mobility.<ref>Smith et al. The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion. Manual Therapy 2008;13:552-559</ref> | ||
== Evidence == | == Evidence == | ||
Hall et al. showed that diagnostic accuracy, sensitivity, and specificity of the FRT were very high (90% and 88% with 92% agreement for experienced examiners (P<.001)). Furthermore, although inexperienced examiners reported greater range for the FRT than experienced examiners, sensitivity, specificity and agreement were still within clinically acceptable levels. The FRT is a useful clinical measure in cervical movement impairment and can assist in the differential diagnosis of [[ | Hall et al. showed that diagnostic accuracy, sensitivity, and specificity of the FRT were very high (90% and 88% with 92% agreement for experienced examiners (P<.001)). Furthermore, although inexperienced examiners reported greater range for the FRT than experienced examiners, sensitivity, specificity and agreement were still within clinically acceptable levels. The FRT is a useful clinical measure in cervical movement impairment and can assist in the differential diagnosis of [[Cervicogenic Headache]]<ref>Hall TM, Robinson KW, AkasakaK. Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test. J Manipulative Physiol Ther. 2008;31:293-300.</ref> | ||
Good levels of inter- and intra-observer reliability were established by Takasaki et al. comparing the manual test outcome with the MRI measurement of cervical segmental rotation. ICCs were greater than 0.7 with narrow 95% confidence interval values for mean range of rotation. These data lend support to the content validity of the FRT as a clinical test of atlanto-axial mobility.<ref>Takasaki et al. Normal kinematics of the upper cervical spine during the Flexion-Rotation test – In vivo measurements using magnetic resonance imaging. Manual Therapy 2011;16:167-171</ref> | |||
It is important to recognize that the FRT is a relatively isolated test of movement impairment of the C1-C2 motion segment, and may not adequately test other motion segments. | It is important to recognize that the FRT is a relatively isolated test of movement impairment of the C1-C2 motion segment, and may not adequately test other motion segments. | ||
Revision as of 16:16, 8 May 2011
Original Editors - Bram Sorel
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Search Strategy[edit | edit source]
Databases used: Pubmed, Pedro
Keywords used: Cervical Flexion-Rotation Test, Cervical Test, Cervical Rotation
Technique[edit | edit source]
Video Fragment: http://www.jospt.org.ezproxy.vub.ac.be:2048/members/media_player.asp?id=2415&vidid=4754
Purpose[edit | edit source]
The Flexion-Rotation Test (FRT), in contrast to other forms of manual examination, is an easily applied clinical test purportedly biased to assess dysfunction at the C1-C2 motion segment. The C1-C2 motion segment accounts for 50% of the rotation in the cervical spine.[1]
Manual examination has high sensitivity and specificity to detect the presence or absence of cervical joint dysfunction in neck pain and headache patients.[2] However, these tests involve high degree of skill on the part of the examiner, and their reliability has been questioned.
In this test procedure, the cervical spine is fully flexed, in an attempt to isolate movement to C1-C2, which has an unique ability to rotate in flexion.
Normal range of rotation motion in end range flexion has been shown to be 44° to each side. In contrast, subjects suffering from headache with C1-C2 dysfunction have an average of 17° less rotation.[3]
Smith et al. concluded that age did not significantly influence mobility during the FRT. One explination for this is that the upper cervical spine undergoes minimal age-related degenerative changes, in comparison to joints lower in the cervical spine. (Dvorak et al., 1992). Also lifestyle factors including sleep position, time spent sitting and side dominant lifestyle did not appear to influence variability in cervical mobility.[4]
Evidence[edit | edit source]
Hall et al. showed that diagnostic accuracy, sensitivity, and specificity of the FRT were very high (90% and 88% with 92% agreement for experienced examiners (P<.001)). Furthermore, although inexperienced examiners reported greater range for the FRT than experienced examiners, sensitivity, specificity and agreement were still within clinically acceptable levels. The FRT is a useful clinical measure in cervical movement impairment and can assist in the differential diagnosis of Cervicogenic Headache[5]
Good levels of inter- and intra-observer reliability were established by Takasaki et al. comparing the manual test outcome with the MRI measurement of cervical segmental rotation. ICCs were greater than 0.7 with narrow 95% confidence interval values for mean range of rotation. These data lend support to the content validity of the FRT as a clinical test of atlanto-axial mobility.[6]
It is important to recognize that the FRT is a relatively isolated test of movement impairment of the C1-C2 motion segment, and may not adequately test other motion segments.
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References[edit | edit source]
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- ↑ Hall TM, Robinson KW, AkasakaK. Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test. J Manipulative Physiol Ther. 2008;31:293-300
- ↑ Sandmark H, Nisell R. Validity of five common manual neck pain provocating tests. Scand J Rehab Med 1995;27:131-136
- ↑ Ogince M, Hall T, Robinson K. The diagnostic validity of the cervical flexion-rotation test in C1/2 related cervicogenic headache. Man Ther 2007;12:256-262
- ↑ Smith et al. The influence of age, gender, lifestyle factors and sub-clinical neck pain on the cervical flexion-rotation test and cervical range of motion. Manual Therapy 2008;13:552-559
- ↑ Hall TM, Robinson KW, AkasakaK. Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test. J Manipulative Physiol Ther. 2008;31:293-300.
- ↑ Takasaki et al. Normal kinematics of the upper cervical spine during the Flexion-Rotation test – In vivo measurements using magnetic resonance imaging. Manual Therapy 2011;16:167-171
