Neck Orthopaedic Test: Cervical rotation lateral flexion Test

The cervical rotation lateral flexion test is a physical examination technique used to assess the mobility of the first rib. It is also known as the cervical side bend test or the cervical transverse process stress test.

Procedure:

1. Position the patient in a seated position with their head and neck in a neutral position.
2. Instruct the patient to rotate their head to one side, without moving their shoulders or upper back.
3. Apply a gentle force to the patient's head, encouraging them to maintain the rotation while tilting their head to the same side, as if they are trying to touch their ear to their shoulder.
4. Observe the patient's range of motion and ask if they experience any pain or discomfort during the test.
5. Repeat the test on the other side by having the patient rotate their head to the opposite side and then laterally flex their head in the same direction.
6. Record any findings and note if the patient experienced pain or restriction during the test.
7. Interpret the results of the test in the context of the patient's overall physical examination and medical history.
8. Determine any further diagnostic or treatment steps as necessary.

The test is considered positive if the patient experiences pain or restriction in their cervical range of motion during the test, which may indicate the presence of 1st rib hypomobility. This condition occurs when the first rib becomes stuck or fixated, limiting its ability to move freely and potentially causing pain or discomfort in the neck, shoulder, or upper back.

References:

1. Cleland JA, Childs JD, McRae M, et al. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127-135. doi: 10.1016/j.math.2004.08.003.
2. Cleland JA, Childs JD, Fritz JM, et al. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007;87(1):9-23. doi: 10.2522/ptj.20060155.
3. Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine. 2002;27(24):2835-2843. doi: 10.1097/01.BRS.0000035681.33745.8D.
4. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39(1):20-27. doi: 10.2519/jospt.2009.2911.
5. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2019;49(11):793-804. doi: 10.2519/jospt.2019.8854.