Rationale: This test helps to reproduce the neuropathic pain felt in nerve root compression.
Technique: The head is extended and side flexed.
Positive test: A positive test causes radicular pain down the arm. Dizziness, blurring of vision or slurring of speech may indicate vertebrobasilar insufficiency.
How do you perform an axial compression test?*
Rationale: To rule out the pathological significance of cervical neck pain in the malingering patient.
Technique: Axial compression of the cervical spine by placing axial pressure through the top of the head whilst the patient is sitting or standing.
Positive test: Reproduction of pain in this instance is rarely pathological.
How is disc prolapse pain diagnosed?*
Rationale: Disc prolapse pain is exacerbated by a Valsalva manoeuvre.
Technique: This is carried out by exhalation against a closed airway. Alternative methods include blowing into a test tube, blowing up a balloon, sneezing or coughing.
Positive test: Reproduction of the patients’ symptoms or discomfort.
What neurological examination of the upper limbs should be performed?*
Rationale: Cervical myelopathy can cause upper motor neuron signs.
Technique: Assess the dermatomes, myotomes and reflexes described in the tables below.
Hoffmann’s sign involves flicking the patient’s middle-finger nail plate. In patients with myelopathy there is a reflex flexion at the distal interphalangeal joint of the index finger.
What are Waddell’s signs?
Rationale: A set of tests and clinical findings that may indicate a non-organic cause of back pain.
Technique: the following features have been reported by Waddell et al.:12
Superficial or diffuse non-anatomical spinal tenderness.
Axial loading.
Repeating straight leg raise during the hip examination or with the patient sitting not reproducing the initial clinical signs.
Non-anatomical weakness or sensory disturbance.
Over-reaction in the patient’s demeanour.
| Disc | Root | Myotomes | Dermatomes | Reflex |
|---|---|---|---|---|
| C4–5 | C5 | Shoulder abduction/deltoid | Lateral arm | Biceps |
| C5–6 | C6 | Elbow flexion/biceps | Lateral forearm, thumb and index finger | Brachioradialis |
| C6–7 | C7 | Elbow extension/triceps | Middle finger | Triceps |
| C7–T1 | C8 | Wrist flexion/long finger flexors | Medial forearm | — |
| T1–2 | T1 | Finger abduction/finger intrinsics | Medial arm | — |
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