Cervical Distraction Test: Difference between revisions
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== Purpose == | == Purpose == | ||
The Cervical Distraction Test is a 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> | The Cervical Distraction Test is a 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. [https://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=6&page=199 Provocation tests in the cervical spine examination: historical basis and scientific analyses]. Pain Physician. 2003;6:199-205</ref> | ||
== Test Position == | == Test Position == | ||
The patient is positioned in supine with the examiner at the patient's head.<ref name="Malange et al" /> The test can also be performed with the patient sitting upright.<ref name="hop" /> | |||
== Technique == | == Technique == | ||
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{{#ev:youtube| xDX_TUesdh0}} | {{#ev:youtube| xDX_TUesdh0}} | ||
The patient lies supine and the neck is comfortably positioned. While standing at the patient's head, the examiner securely grasps the patient either by placing each hand around the patient’s mastoid processes, or placing one hand on the 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> | ||
== 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 & Extremities. Pg 126- 127.</ref> | Neural foramen and joint capsules around the facet joints of the cervical spine are tested during the Cervical Distraction Test. The neck extensor muscles are also secondarily observed during this test.<ref name="hop">Hoppenfeld, Stanley. Physical Examination of the Spine & 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. | If pain is relieved as a result of the movement, then the test is positive for nerve root compression and facet joint pressure. The grade of the pressure would be determined 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 | Common errors by the examiner would include improper positioning of the examiner, and or improper positioning of the examiner's hands. Common errors by the patient include slumping (not sitting up straight) during the seated version, 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 == | ||
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. | 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.<ref name="Wainner et al" /> | ||
== Cluster and Related Tests == | |||
*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) | |||
The test item cluster included: | **Involved cervical rotation less than 60 degrees | ||
**Positive Spurling's test | |||
*Positive ULTT (median) | **Positive distraction test '''LR+ of 30.3 if all 4 tests are positive.'''<ref name="Wainner et al" /> | ||
*Involved cervical rotation less than 60 degrees | *[[Spurlings Test|Spurling's 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 | ||
*Positive | |||
*Positive distraction test | |||
'''LR+ of 30.3 if all 4 tests are positive.'''<ref name="Wainner et al" /> | |||
*[[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 | *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 | ||
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Purpose[edit | edit source]
The Cervical Distraction Test is a diagnostic test for the presence of Cervical Radiculopathy.[1][2]
Test Position[edit | edit source]
The patient is positioned in supine with the examiner at the patient's head.[2] The test can also be performed with the patient sitting upright.[3]
Technique[edit | edit source]
The patient lies supine and the neck is comfortably positioned. While standing at the patient's head, the examiner securely grasps the patient either by placing each hand around the patient’s mastoid processes, or placing one hand on the forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force[4]
A positive test is the reduction or elimination of symptoms with traction.[4]
Tissues being tested[edit | edit source]
Neural foramen and joint capsules around the facet joints of the cervical spine are tested during the Cervical Distraction Test. 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. The grade of the pressure would be determined 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 positioning of the examiner, and or improper positioning of the examiner's hands. Common errors by the patient include slumping (not sitting up straight) during the seated version, 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.[5]
Cluster and Related Tests[edit | edit source]
- 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 Spurling's test
- Positive distraction test LR+ of 30.3 if all 4 tests are positive.[5]
- Spurling's 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
Evidence[edit | edit source]
- Sensitivity: 0.44
- Specificity: 0.97[6]
- Reliability: 0.88[5]
References[edit | edit source]
- ↑ Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in Motion:2008.
- ↑ 2.0 2.1 Malange GA,Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205
- ↑ 3.0 3.1 3.2 3.3 Hoppenfeld, Stanley. Physical Examination of the Spine & Extremities. Pg 126- 127.
- ↑ 4.0 4.1 Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT.2000 Dec;30(12):728-744.
- ↑ 5.0 5.1 5.2 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.
- ↑ 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.
