This is Brent of the BrookBush Institute, and in this video we're going to do
the cervical distraction test for cervical radiculopathy. I'm going to have my
friend a Yvette come out, she's going to help me demonstrate. This is a very simple
test, however it is specific as well. The research shows that this has high-
specificity low-sensitivity, so keep that in mind. If you get a yes we have a good
indicator for a diagnosis, if you get a no you actually don't have much keep,
going through your cervical radiculopathy cluster. The test
works like this, so if she's having symptoms right now, let's say that she
came in she has right-sided neck pain, she has some tingling into
her fingers, maybe she's getting some other random arm associated pains.
So we know that we have these indicators that a nerve is not very happy, what
we're going to try to do is open up the foramen, that's kind of what
this whole test is based on, and the way we're going to do that is by distracting or
creating some traction in our cervical spine. So the way you're going to do that is,
I actually just took my hand, put this part right underneath her cervical ridge
right here, alright so I got good purchase and then I'm going to take this
hand and just lightly place under her chin. In my case my hands are
kind of big, only a couple of my fingers underneath her chin. If you are
familiar with like chin cradle grip for mobilizations and manipulations, you
could get into that position, so if that's comfortable for you go ahead and
do that. What we're going to do is okay so you were feeling some stuff
down here, and you feel that stuff in your fingers, okay let's see
if it goes away when I want to traction your neck alright. So I'm
going to pull her to end of range in traction, that's the end of
arthrokinematic range. Hey Yvette how does that feel? (Okay feels
better). Better, okay so if that feels better that's a
positive sign for this test, you have a positive cervical distraction
test. Now I'll show you the other way. So what I did
hand underneath right here, alright that nuchal line, you want
to look that up on your Anatomy. I'll put my fingers underneath like this,
and of course I'm very comfortable with that chin cradled grip from doing
my manipulations and stuff, and I'm just going to pull back until end of arthrokinematic
range, again now I'm going to go hey Yvette how does that feel? The hard part
is letting their chin go so that you can actually have them say something, and
what I'm doing is most of my forces in the occiput hand right, most of the
force I'm generating, and sometimes what I'll do is I'll use my forearm kind of
against this part of their face to help provide a little bit more tension
as opposed to pulling up real hard on the chin which can be really
uncomfortable. I know it it might be counterintuitive to think that force
across here would be less irritating, but generally speaking it is. Now a positive
for this test is symptoms decreased with traction, but let me posit this to you, if
you got symptoms with traction I wouldn't discount that as a sign in your
evaluation. I think if you traction and it causes more pain you still have a
chance, or a good chance or a good indicator that the cervical spine is
involved. I know from a personal account I actually had a couple herniated discs
and brachial neuritis at one point, if somebody tractioned me my symptoms went
through the roof. Alright so we could maybe take a step back, think about how
this test works and since you know nerve roots could get
stretched in this a little bit, if we pull
out maybe we should say if there is a change
in symptoms that might be a positive. So traditionally it says if we
reduce symptoms that's a positive, I'm saying think about if there's a change
in symptoms maybe that's a positive for this test. Remember that all you're doing
is traction for the cervical spine, and as far as your evaluations in clinic the
only time I actually use this test is part of a cluster. So we want to
cluster our tests and get the highest accuracy we can if we're going to
stick with our evidence-based approach. if you have any questions at all
leave them in the comments box below.