REIDER PART 270

330 Chapter 8 Cervical and Thoracic Spine

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Figurę

8-46C). The examiner s right hand is then used to depress the patient s shoulder (Fig. 8-46D). The patients shoulder is externally rotated and then abducted, approximating the patient s hand to his or her own ear (Fig. 8-46E). Asking the patient to Iaterally bend the neck away from the side being tested places additional tension on the nerve roots (Fig. 8-46F)_y whereas bending toward the side being tested relaxes the tension somewhat. In response to the ULTT3 maneuver, normal subjects feel a tugging sensation in the axilla. The response is considered abnormal if the patient feels pain radiating down the arm past the elbow to the ring and little fingers (C8) or into the axilla (Tl).

Additional nerve root tension can be added by having an assistant perform a simultaneous straight-leg raise on the ipsilateral side or by performing the test in the slump position. If the slump variant is selected, the ULTTs arc performed as describcd but with the patient seated. The patient is asked to maximally flcx the trunk and hips while keeping the knees extended. This places the cauda eąuina under stretch and provides additional tension.

8-46, cont'd.

Miscellaneous Special Tests

AxiAL COMPRESSION TEST

The axial compression test and Spurling’s test are designed to determine whether axial compression elic-its or aggravates the patient s painful symptoms. They should not be performed when nerve root compression with a motor defieit is suspected or detected. To perform the axial compression test, the examiner stands behind the patient who is seated with the ccrvical spine in a neutral position. The examiner then places both hands at the crown of the patienTs head and com-presses, thus supplying an axial load (Fig. 8-47A). The application of the force should be gentle and gradual because it may elicit a very painful response. The patient is asked to report whether the maneuver pro-duces pain or other unpleasant sensations, as well as the quality and distribution of the symptoms crcated. A distraction test of the neck may rclieve the symptoms (Fig. 8-47B).

Figurę 8-47. A, Axial compression test. B, Distraction test.

A B