Extension Rotation Test | Vertebrobasilar Insufficiency (VBI)
The vertebral artery supplies blood flow to the hindbrain and courses through the transverse foramina of the cervical levels from C6 to C1 and is tethered at foramina C2, C1, and the atlanto-occipital membrane. Abnormal stress (amongst others through cervical rotation) on this artery may lead to a reduction of blood flow to the hindbrain, which we call vertebrobasilar insufficiency or VBI– a condition that can develop into cerebral or brain stem ischemia and lead to severe morbidity or death.
Our most important tool to evaluate our patient’s individual presentation is amongst others our knowledge about the pathophysiology, risk factors of arterial dysfunction, and above all awareness of the classical vascular clinical presentation coupled with a high index of suspicion. Watch our video on those topics first before you carry on!
The goal of pre-manipulative vertebrobasilar testing is to evaluate the adequacy of blood supply to the brain by compressing the vertebral artery and to examine for the onset of signs and symptoms indicative of VBI.
Hutting et al. (2013) have conducted a systematic review of the extension rotation test and have found a low sensitivity ranging from 0-57% and a moderate to good specificity ranging from 67-100%. For this reason, a surplus value for pre-manipulative tests seems unlikely.
To perform this test, have your patient in supine lying position with his head above the edge of the table.
Support your patient’s head, rotate it submaximally to one side, and bring his head into extension.
Hold this position for 30 seconds, talk to the patient or have him count to 20 to look for changes in speech and monitor his eyes to notice a possible nystagmus.
Because we are compromising the blood flow through the artery in the opposite direction of the rotation, we are actually testing the vertebral artery on the side of rotation which has to compensate for the decrease in blood supply to the hindbrain.
All typical signs and symptoms indicative of VBI, which indicate a positive test can be seen in the overview table here:
All of those are absolute contraindications to cervical manipulation making an urgent referral to the GP or specialist necessary.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
In order to screen for cervical artery dysfunction, it is recommended to assess the cranial nerve function of nerves VIII to XII:
Cranial Nerve VIII: Vestibulocochlear Nerve
Cranial Nerve IX & X: Glossopharyngeal & Vagus Nerve
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.