The influence of lower cervical joint pain on range of motion and interpretation of the flexion-rotation test

J Man Manip Ther. 2010 Sep;18(3):126-31. doi: 10.1179/106698110X12640740712293.


Objective: The purpose of this study was to investigate the impact of lower cervical facet joint pain (CFP) on the flexion-rotation test (FRT).

Methods: A single blind, comparative group design was used to investigate whether lower CFP influences FRT mobility and examiner interpretation. Twenty-four subjects were evaluated, 12 with cervicogenic headache (age 26-63 years) and 12 with lower CFP (age 44-62 years), confirmed by therapeutic cervical facet joint intervention. A single blinded examiner conducted the FRT, reporting the test state (positive or negative) before measuring range of motion using a goniometer. Subjects with lower CFP were evaluated by the FRT prior to therapeutic intervention and were excluded from analysis if they did not gain complete symptomatic relief following the procedure. Only subjects with immediate complete relief were included.

Results: The average range of unilateral rotation to the limited side during the FRT was 26 and 37.5° for the cervicogenic headache and lower CFP groups respectively. The difference between groups was significant (P<0.01). Sensitivity and specificity for cervicogenic headache diagnosis was 75 and 92% respectively. A receiver operating curve revealed that an experienced examiner using the FRT was able to make the correct diagnosis 90% of the time (P<0.01), with a positive cut-off value of 32°.

Discussion: These findings provide further evidence for the clinical utility of the FRT in cervical examination and cervicogenic headache diagnosis.

Keywords: Cervicogenic headache; Diagnostic accuracy; Flexion–Rotation test; Sensitivity; Specificity.