Cervical Distraksjon test

The Cervical Distraction Test is used in the assessment of patients with suspected cervical radiculopathy. The goal is to evaluate whether traction relieves the patient’s symptoms, which may indicate nerve root compression in the cervical spine¹.

Test Position

The patient lies supine with the neck in a neutral and relaxed position. The test can also be performed in sitting, but the supine position usually provides greater control and consistency².

Execution

• Stand at the head of the treatment table.

• Place your hands either:

  • Around both mastoid processes, or

  • One hand on the patient’s forehead and the other at the occiput.

• Apply slight cervical flexion.

• Gradually apply a controlled traction force along the axis of the cervical spine by pulling the head toward your chest while stabilizing the patient’s torso.

• Hold the stretch for several seconds and observe the patient’s response³⁴..

Interpretation

• Positive test: Symptoms in the arm or neck are reduced or eliminated during traction, indicating nerve compression or relief of pressure in the intervertebral foramen²⁴.

• Negative test: No symptom change, or possible worsening.

• A positive result suggests that structures such as nerve roots or facet joints contribute to the patient’s symptoms, particularly if relief is clear.

Structures Assessed

• Nerve roots within the intervertebral foramina

• Facet joint capsules and surrounding structures

• Secondary observation of cervical extensor muscle response²

Clinical Significance

In degenerative changes of the cervical spine – such as reduced disc height or osteophyte formation – nerve roots can become compressed. Traction increases the intervertebral space, potentially reducing compression and alleviating symptoms. This makes the test useful both diagnostically and as a therapeutic tool in manual traction⁵.

Common Errors

• Incorrect hand placement or insufficient/incorrectly angled traction force

• Patient tensing neck muscles or slumping when seated, reducing test validity²

Use in Test Cluster

The Cervical Distraction Test is part of a recommended test cluster for cervical radiculopathy. According to Wainner et al. (2003), diagnostic accuracy is very high if multiple tests are positive:

• ULTT (Upper Limb Tension Test – median nerve)

• Cervical rotation <60° toward the affected side

• Spurling’s Test

• Cervical Distraction Test

If all four are positive, the likelihood ratio (LR+) for cervical radiculopathy is extremely high (30.3)⁵.

Differential Value Compared to Other Tests

• Spurling’s Test: Reproduces pain and helps side-localize the lesion.

• Cervical Compression Test: Increases symptoms, opposite to the Distraction Test which relieves them.

Evidence and Diagnostic Accuracy

• Sensitivity: 0.44

• Specificity: 0.97

• Test-retest reliability (ICC): 0.88⁵⁶

These values indicate that the test has low sensitivity (poor at detecting all cases), but very high specificity (excellent at confirming diagnosis when positive).

Sources:

1. Malange GA, Landes P, Nadler SF. Provocation tests in the cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003;6:199–205.

2. Hoppenfeld S, Thomas H, Hutton R. Physical Examination of the Spine & Extremities. New York: Prentice Hall; 1976. s. 126–127.

3. Cervical Distraction Test – YouTube. (sist åpnet 05.07.2025)

4. Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. 2000;30(12):728–744.

5. 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.

6. Rubinstein SM, Pool JJM, van Tulder MW, Riphagen II, de Vet HCW. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007;16:307–319.