Cervical Distraction Test

Original Editor - Nikki Arnold

Top Contributors - Venus Pagare, Nikki Arnold, Laura Ritchie, Melissa Billy and Dan Rhon

Purpose

The Cervical Distraction Test is a diagnostic test for the presence of Cervical Radiculopathy.[1][2]

Test Position

Supine or sitting upright[3]

Technique

[4]

Patient lies supine and the neck is comfortably positioned. Examiner securely grasps the patient's either by placing each hand around the patient’s mastoid processes, while standing at their head, or place one hand on their forehead and the other on the occiput. Slightly flex the patient’s neck and pull the head towards your torso, applying a distraction force[5]

A positive test is the reduction or elimination of symptoms with traction .[5]

Tissues being tested

Neural foramen and joint capsules around the facet joints of the cervical spine. The neck extensor muscles are also secondarily observed during this test.[3]

Positive Test

If pain is relieved as a result of the movement, then the test is positive for nerve root compression and facet joint pressure. Determining the grade of the pressure would be decided by the amount of pressure and pain relieved while performing the test.[3]

Common Errors

Common errors by the examiner would include improper position of the examiner, and or improper position of the examiners hands. Common errors by the patient include slumping (not sitting up straight), and not relaxing the muscles of the neck and spine which can result in an altered outcome of the test.[3]

Importance of Test

As disc height decreases and bone spurs accumulate, the space for nerves to enter and exit the vertebral canal gets smaller. The decreased space can result in greater pressure on the nerve roots or other innervated structures, causing pain and weakness. With distraction, the joint space is increased to relieve the pressure on the nerve roots, thus decreasing the symptoms.

Also, this test has been utilized in a cluster of special tests to more accurately identify cervical radiculopathy with a “clinical prediction rule”. According to Wainner et al. in 2003:

The test item cluster included:

  • Positive ULTT (median)
  • Involved cervical rotation less than 60 degrees
  • Positive Spurlings test
  • Positive distraction test

LR+ of 30.3 if all 4 tests are positive.[6]

Related Tests

  • Spurlings Test: superior to the distraction test in that it would be more specific to the exact side or portion of the cervical spine that is affected
  • Cervical Compression Test: equal to the cervical distraction test as it is testing for the same tissues, but instead of relieving pain, the movement reproduces pain

Evidence

References

  1. Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. United States; Evidence in Motion:2008.
  2. Malange GA,Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199-205
  3. 3.0 3.1 3.2 3.3 Hoppenfeld, Stanley. Physical Examination of the Spine & Extremities. Pg 126- 127.
  4. Physiotutors. Cervical Distraction Test | Cervical Radicular Syndrome. Available from: https://www.youtube.com/watch?v=uLdzgd5snmw
  5. 5.0 5.1 Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Ortho Sports PT.2000 Dec;30(12):728-744.
  6. 6.0 6.1 Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
  7. Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systemic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J.2007;16:307-319.