J. Scott Pritchard, DO

2012 NADE NATIONAL TRAINING CONFERENCE

1. Pins/Needles2. Hammer3. Tuning fork4. Flash light5. Measuring tape6. Calipers7. Monofilaments- Semmes-Weinstein8. And

1. numbness- deprived of the power to move or feel

normally2. Tingling - a pricking or stinging sensation or feeling3. Paresthesia- skin sensation of burning, prickling

or tingling with no apparent cause. 4. Pain- an intense unpleasant feeling caused by damaging stimuli

1. Motor – strength – assessed per MRC scale 0/5 no movement-5/5- normal - tone - continuous passive partial contraction of a muscle

- atrophy- loss of muscle mass -spasticity- altered tone w/stiffness and involuntary muscle spasms. Ashworth scale – 0 to 5

2. Sensory- temperature touch pinprick proprioception 2- pt discrimination vibration

Normal 2- pt discrimination 0-4 mm Intermediate – 5-7 mm Abnormal > 7mm

3. Coordination – primary assessment of cerebellar function - Smooth combination of both spatial direction and

kinetic(forceful) movement - Functional abnormalities can be seen in altered

gait, truncal ataxias, dysmetrias of the extremities, altered rapid alternating movements of the upper/lower extremities. (F-T-N and RAM).

- Ataxia – impaired coordination

1. Hemiparetic2. Paraparetic3. Sensory4.Steppage5. Waddling6.Festination7. Retropulsion8. Astasia Abasia

Compressive neuropathy of the median nerve

1. numbness, tingling of the thumb and first two digits of the hand 2. increased numbness and onset of

pain 3. sense of weakness or dropping things 4. most intense at night 5. progressive motor and sensory loss

In one study 64% of 88 hands w/+ Phalen’s test has positive EMG findings

Conversely 51% of 78 hands with negative Phalen’s testing had positive EMG findings

CTS requires both clinical symptoms, findings and EMG evidence to establish its presence and severity

Compressive neuropathy of the ulnar nerve 1. pain and numbness in the elbow 2. tingling, especially ring and 5th digit 3. weakness in the 4th/5th fingers 4. decreased ability to pinch thumb/5th

digit 5. decreased overall hand grip 6. muscle wasting in the hand 7. claw-like deformity of the hand

1. burning pain/allodynia 2. increased pain w/onset of swelling 3. development of osteoporosis and muscle

atrophy 4. irreversible contractures and immobility

The affected extremity may be cool to touch and appear mottled. Swelling may be present.

Extreme sensitivity of the skin to touch. Often unable totolerate clothing

CRPS I – no demonstrable nerve lesions (RSD,

Sudek’s atrophy)

CRPS II – obvious nerve damage(causalgia) usually

more painful and difficult to control

1. History and physical examination2. Thermography3. Sweat Testing4. EMG5. Bone scan6. X-ray findings

1. Waddell’s2. Leseque(SLR) now nerve stretch test3. Hoffman’s sign4. Wartenburg’s sign5. Pronator drift6. Gower’s sign7. Meralgia paresthetica8. Double-crush syndrome