Movements and Orthopedic Tests: quick, easy, and reliable

CERVICAL and THORACIC SPINE TESTS

Tests for topical diagnosis of the cervical and thoracic spine

Movements testing

The movement tests design to evaluate the involvement in the pathological process particular muscles, nerves and nerve roots. The examiner should not only to conduct the tests but also observe how the patient executes the particular movements. These tests can help localize a lesion to the particular cortical or white matter region, spinal cord level, nerve root, peripheral nerve, or muscle. Movement tests quantify by using muscle strength (MS). All tests and movements testing in particular depend on the patient’s cooperation and sufficient efforts. If the patient consciously or unconsciously unable to cooperate, the examiner should document “insufficient efforts” and try to observe and appreciate MS indirectly. For example, observe the patient’s ability to put on/ takes off clothes, lace shoes, fasten buttons and zips and write/ type on a computer during fill out the office papers. The examiner may quickly test of the upper extremity movements analyzing muscle strength of the certain muscles. Testing of the strength of each muscle group should be performed in a consistent uniform order. The examiner should test symmetrical muscles started with the dominant extremity. MS is rated on a scale of 0/5 to 5/5:

• 0/5: no contraction.
• 1/5: muscle flicker, but no movements.
• 2/5: movement possible, but not against gravity (test the joint in its horizontal plane).
• 3/5: movement possible against gravity, but not against resistance by the examiner.
• 4/5: movement possible against some resistance by the examiner. This is the most common category. This category is divided into three subcategories: 4–/5, 4/5, and 4+/5. However, this is a very subjective.
• 5/5: normal strength.

Quick topical diagnosis of the cervicothoracic spinal segments and muscles

Movements

Cervicothoracic segments

Major muscles

Elbow Flexion

C5

Biceps, Brachialis

Wrist Extension

C6

Extensor Carpi Radialis Longus and Brevis

Elbow Extension

C7

Triceps

Middle Finger Flexion

C8

Flexor Digitorum Profundus to the middle finger

Small Finger Abduction

T1

Flexor Digitorum Profundus

Movement tests of upper extremities

Action

Muscles

Nerves

Cervicothoracic segments

Finger Extension

Extensor Digitorum, Extensor Indicis, Extensor Digiti Minimi

Radial nerve (posterior interosseous nerve)

C7, C8

Thumb ABDuction* in plane of palm

Abductor Pollicis Longus

Radial nerve (posterior interosseous nerve)

C7, C8

Finger ABDuction*

Dorsal Interossei, Abductor Digiti Minimi

Ulnar nerve

C8, T1

Finger and thumb ADDuction* in plane of palm

Adductor Pollicis, Palmar Interossei

Ulnar nerve

C8, T1

Thumb Opposition

Opponens Pollicis

Median nerve

C8, T1

Thumb ABDuction* perpendicular to plane of palm

Abductor Pollicis Brevis

Median nerve

C8, T1

Flexion at distal interphalangeal joints digits 2, 3

Flexor Digitorum Profundus to digits 2, 3

Median nerve

C7, C8

Flexion at distal interphalangeal joints digits 4, 5

Flexor Digitorum Profundus to digits 4, 5

Ulnar nerve

C7, C8

Wrist Flexion and hand ABDuction*

Flexor Carpi Radialis

Median nerve

C6, C7

Wrist Flexion and hand ADDuction*

Flexor Carpi Ulnaris

Ulnar nerve

C7, C8, T1

Wrist Extension and hand ABDuction*

Extensor Carpi Radialis

Radial nerve

C5, C6

Elbow Flexion (with forearm supinated)

Biceps, Brachialis

Musculocutaneous nerve

C5, C6

Elbow Extension

Triceps

Radial nerve

C6, C7, C8

Arm ABDuction* at shoulder

Supraspinatus initiates abduction of the arm from 0 to 15°. Beyond 15° the Deltoid becomes more effective at abducting the arm and becomes the main propagator of the ABDuction

Axillary nerve

C5, C6

*I capitalized first three letters in words Abduction and Adduction to distinguish the opposite movements.

Bakody Sign

Indications: suggestive for the cervical radiculopathy at the levels of C4-C6. Test is indicative for the nerve root irritation due to cervical foraminal compression.

Patient’s position: sitting upright.

Technique: Either the patient actively, or the examiner passively, place the patient’s hand on top of his/her head.

Interpretation: the test is positive if the patient reports decrease pain.

Clinical Notes: Reverse Bakody Sign can be noted when the patient resists raising the arm and hand toward the head. This finding should be correlated with other orthopedic testing, as it could indicate facet irritation, glenohumeral dysfunction, rotator-cuff trauma or myofascial spasm.

Doorbell Sign (Anterior Cervical Doorbell Push...