Special Tests: Cervical Radiculopathy, Cervicogenic Headache, and Canadian C-spine Rules
by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS
For an introduction to Special Tests including definitions of specific terminology, what special tests measure, how we chose the tests in these lessons, and best use, check out:
Special Tests Covered in this Lesson:
- Wainner's Clinical Prediction Rule for Cervical Radiculopathy
- Spurling's Compression Test
- Upper Limb Tension Test
- Distraction Test
- Less than 60° of rotation on the affected side
- Additional Radiculopathy Test
- Cervicogenic Headache
- Red Flags
Summary:
The special tests that demonstrate an acceptable level of accuracy for the cervical spine focus on just a few diagnoses, and likely miss the most common cervical complaints. Radiculopathy, cervicogenic headache, upper cervical spine instability, vertibrobasilar ischemia and screening for necessary imaging are covered in these courses. These diagnoses do not include the common complaints of mechanical/postural chronic neck pain. Clinical experience and a comprehensive subjective examination will likely dictate whether the testing below is necessary. The most accurate tests, based on available research, were chosen for each potential diagnosis.
- Cervical Radiculopathy: Generally, cervical radiculopathy tests are more specific than sensitive. For example, the Wainner's Clinical Prediction Rule (CPR), a cluster of radiculopathy tests, demonstrates very high specificity but low sensitivity (12). However, further consideration should be given to the Upper Limb Tension Tests (ULTTs). By definition, the diagnosis of radiculopathy involves nerve root symptoms, so the inability to demonstrate nerve/nerve root irritation using these relatively sensitive tests (4, 6, 12, 15, 16 - 19) may provide a useful screen. It is puzzling that the ULTTs were included in the Wainner CPR, which demonstrated low sensitivity (12).