Spine
Cervical Spine
Evidence: uncertain
Vertebral Artery Test (VBI) Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Screening for Vertebrobasilar Insufficiency (VBI) before performing cervical manipulation.
How to Perform
- Position: Patient supine with head off the table.
- Action: Examiner passively extends the neck, laterally bends, and rotates the head to the same side. Hold for 30 seconds.
- Observation: Patient keeps eyes open. Talk to them to check speech.
Interpretation of Results
- Positive Test: Dizziness, nystagmus (eye flickering), slurred speech (dysarthria), or nausea (The '5 Ds').
- Why: This position compresses the vertebral artery on the contralateral side. If the ipsilateral artery is blocked/stenotic, blood flow to the brainstem drops.
Diagnostic Accuracy
- Sensitivity: 0-57% (Low)
- Specificity: 67-100%
Clinical Context & Limitations
The Vertebral Artery Test (VBI) should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Spine region, combining the Vertebral Artery Test (VBI) with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
