Execution
- 1Position the patient supine with the head supported.
- 2Passively flex the cervical spine fully to bias motion to the upper cervical spine.
- 3Maintain full cervical flexion and passively rotates the head to one side until firm resistance, pain, or symptom reproduction occurs.
- 4Measure or estimates the available rotation and repeat to the opposite side.
- 5Compare side-to-side range, symptom reproduction, and end feel.
Positive outcome
The test is positive when rotation is clearly restricted, commonly less than about 32° to 33°, or when there is a side-to-side difference of 10° or more with reproduction of familiar cervicogenic headache. The test most strongly implicates C1-C2 when lower cervical motion is locked in full flexion. Dizziness, neurological symptoms, or vascular-type symptoms during the test require stopping and reassessment.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Ogince et al. (2007) | k=0.81 | 91 | 90 | 9.1 | 0.10 |
| Hall et al. (2008) | substantial agreement | 90 | 88 | 7.5 | 0.11 |
| Hall et al. (2010) | NA | NA | NA | NA | NA |
CommentCFRT has some of the better diagnostic evidence in the cervicogenic-headache group, especially for C1-C2 related headache. It should not be used as a general dizziness screen or as proof of headache source by itself. Its value improves when restricted CFRT is paired with painful upper cervical joint dysfunction and deep neck flexor impairment.
High Clinical Value