Normative Responses to Clinical Tests for Cervicogenic Dizziness: Clinical Cervical Torsion Test and Head-Neck Differentiation Test

Background. The clinical diagnosis of cervicogenic dizziness (CGD) is challenging because of a lack of sensitive and specific diagnostic tests. It is vital for clinicians to know normative responses to suggested clinical tests to help them develop the method and interpretation of these tests and maximize their diagnostic value for CGD. Objective. The purpose of the study was to determine normative responses to the clinical application of the cervical torsion test and the head-neck differentiation test, with consideration of different age groups and sex. Design. This was an observational study. Methods. One hundred forty-seven people who were healthy and asymptomatic served as controls and performed both tests, which involved 3 components: cervical torsion, cervical rotation, and en bloc rotation (head and trunk rotation together). Results. Thirty-five (23.81%) of the 147 participants reported some symptoms (mild dizziness, visual disturbances, unusual eye movements on opening eyes after the test, motion sickness, or nausea) on 1 or more of the 3 test components in either test. The specificity when using a positive response to torsion alone (ie, a negative response to the rotation or en bloc component) was high (for the cervical torsion test, 98.64%; for the head-neck differentiation test, 89.8%), as participants with likely global sensorimotor sensitivity were eliminated. The combined specificity was 100%, as no participants presented with exclusive positive torsion results in both tests. Age and sex did not influence the results. Limitations. There were several examiners who were not blinded. Conclusions. Confirmation of the high specificity of these clinical tests with the method used in this study to conduct and interpret the results will allow future research to determine the sensitivity of these clinical measures in a population with CGD and specificity in those with dizziness of other origins.
Dizziness is a common symptom associated with several different head and neck conditions. (1,2) Differential diagnosis is especially important after trauma to the head and neck, such as in whiplash [...]