Peripheral Based Tests - goeata.org...• Cubital Tunnel Syndrome • entrapment at Guyon’s canal...
Transcript of Peripheral Based Tests - goeata.org...• Cubital Tunnel Syndrome • entrapment at Guyon’s canal...
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Peripheral Based Tests
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Median Nerve Test 1
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Median Nerve Test 1
• Indications• medial elbow pain • pain at palmar aspect of wrist, thumb
• Areas of palpation• anterior to ulnar N at brachium • medial to distal biceps tendon • deep to pronator trees • carpal tunnel
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Median Nerve Test 1
• Sequence1. Glenohumeral abduction (90-110 deg) 2. GH external rotation (90 deg) 3. Forearm supination 4. Wrist/finger extension 5. Elbow extension
• Structural Differentiation• wrist - proximal symptoms • cervical spine contralateral lateral flexion - distal symptoms
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Median Nerve Test 2
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Median Nerve Test 2
• Indications• median nerve distribution pain • primarily when provoked by scapular depression
• Areas of palpation• next to ulnar N at brachium • medial to distal biceps tendon • deep to pronator trees • carpal tunnel
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Median Nerve Test 2• Sequence
1. Scapular depression 2. Elbow extension 3. External Rotation/Supination 4. Wrist/finger extension 5. GH abduction (if needed)
• Structural Differentiation• scapular depression released - distal symptoms • wrist/fingers released - proximal symptoms
• Sensitizing Movements• cervical spine contralateral lateral flexion
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Radial Nerve Test
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Radial Nerve Test
• Indications• lateral elbow pain - lateral epicondalgia • lateral forearm pain • radial aspect of wrist/thumb - De Quervains syndrome
• Areas of palpation• radial groove • distal radius
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Radial Nerve Test• Sequence
1. Scapular depression 2. Elbow extension 3. Internal Rotation/Pronation 4. Wrist/finger flexion 5. GH abduction
• Structural Differentiation• scapular depression released - distal symptoms • wrist released - proximal symptoms
• Sensitizing Movements• cervical spine contralateral lateral flexion
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Ulnar Nerve Test
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Ulnar Nerve Test• Indications
• C8 radiculopathy • Thoracic Outlet Syndrome • Cubital Tunnel Syndrome • entrapment at Guyon’s canal
• Areas of palpation• medial brachium, posterior to median N • cubital tunnel • immediately distal to cubital tunnel • Guyon’s Canal
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Ulnar Nerve Test• Sequence
1. Scapular depression 2. Wrist/Finger extension 3. Forearm Pronation 4. Elbow Flexion 5. GH external rotation 6. GH abduction
• Structural Differentiation• scapular depression released - distal symptoms • wrist released - proximal symptoms
• Sensitizing Movements• cervical spine contralateral lateral flexion • radial deviation
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Musculocutaneous Nerve Test
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Musculocutaneous Nerve Test• Indications
• C8 radiculopathy • Thoracic Outlet Syndrome • Cubital Tunnel Syndrome • entrapment at Guyon’s canal
• Areas of palpation• medial brachium, posterior to median N • cubital tunnel • immediately distal to cubital tunnel • Guyon’s Canal
![Page 16: Peripheral Based Tests - goeata.org...• Cubital Tunnel Syndrome • entrapment at Guyon’s canal • Areas of palpation • medial brachium, posterior to median N • cubital tunnel](https://reader031.fdocuments.in/reader031/viewer/2022012001/6085e427a47e3f5d3e521069/html5/thumbnails/16.jpg)
Musculocutaneous Nerve Test• Sequence
1. Scapular depression 2. Elbow Extension 3. Shoulder extension 4. Ulnar deviation of wrist/thumb flexion
• Structural Differentiation• release contralateral lateral flexion of cervical spine • radial deviation of wrist
• Sensitizing Movements• cervical spine contralaterateral lateral flexion
![Page 17: Peripheral Based Tests - goeata.org...• Cubital Tunnel Syndrome • entrapment at Guyon’s canal • Areas of palpation • medial brachium, posterior to median N • cubital tunnel](https://reader031.fdocuments.in/reader031/viewer/2022012001/6085e427a47e3f5d3e521069/html5/thumbnails/17.jpg)
Axillary Nerve Test
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Axillary Nerve Test
• Indications• Quadrilateral space symptoms/swimmers, throwers • Posterior/Lateral shoulder pain
• Areas of palpation• quadrilateral space
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Axillary Nerve Test• Sequence
1. Contralateral lateral flexion of the cervical spine 2. Scapular depression 3. GH internal rotation 4. GH abduction (if IR doesn’t evoke symptoms)
• Structural Differentiation• release cervical spine contralateral lateral flexion
• Sensitizing Movements• cervical spine contralaterateral lateral flexion
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Radial Sensory Nerve Test
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Radial Sensory Nerve Test
• Indications• DeQuervains syndrome • thumb pain
• Areas of palpation• distal radius • snuffbox
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Radial Sensory Nerve Test• Sequence
1. Scapular depression 2. GH internal rotation/elbow extension/forearm pronation 3. Thumb flexion/adduction 4. Ulnar deviation
• Structural Differentiation• release scapular depression
• Sensitizing Movements• cervical spine contralateral lateral flexion
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Straight Leg Raise (SLR)
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Straight Leg Raise (SLR)
• Indications• Posterior hip/LE pain • Heel pain
• Areas of palpation• Sciatic Notch • Posterior thigh
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Straight Leg Raise (SLR)• Sequence
1. Knee stabilized in extension 2. Hip flexion (no knee flexion allowed)
• Structural Differentiation• ankle dorsiflexion - proximal symptoms
• Sensitizing Movement• hip IR/add • ankle movements discussed in depth later
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Tibial Nerve Test
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Tibial Nerve Test
• Indications• Heel pain/plantar fasciitis • Medial ankle pain
• Areas of palpation• Tarsal Tunnel • Popliteal space - between two dimples
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Tibial Nerve Test
• Sequence1. Dorsiflexion/Eversion 2. Straight Leg Raise Test
• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction
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Peroneal Nerve Test
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Peroneal Nerve Test
• Indications• anterolateral leg/ankle pain • lumbar radicular pain
• Areas of palpation• posterior to fibular head • tunnel for superficial peroneal nerve • anterior ankle • between extensor hallicus and digitorum tendons
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Peroneal Nerve Test
• Sequence1. Plantarflexion/Inversion of the ankle/foot 2. Straight Leg Raise Test
• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction
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Sural Nerve Test
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Sural Nerve Test
• Indications• lateral ankle/foot pain • cuboid syndrome • peroneal tendinitis
• Areas of palpation• posterior to lateral malleolus
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Sural Nerve Test
• Sequence1. Dorsiflexion/Inversion of the ankle/foot 2. Straight Leg Raise Test
• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction
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Femoral Nerve Test
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Femoral Nerve Test
• Indications• back pain • thigh/hip flexor pain • knee pain
• Areas of palpation• anterior pelvis/inguinal ligament
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Femoral Nerve Test• Sequence
1. passive prone knee flexion
• Structural Differentiation2. passive prone knee flexion 3. passive prone knee flexion with manual stability of
pelvis 4. pressure on pelvis
• Sensitizing Movement• Hip extension
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Femoral Slump
pic of femoral slump position
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Femoral Slump
• Indications• thigh/groin/hip flexor pain • knee pain
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Femoral Slump• Sequence
1. pt in side lying (test side down) with head on a pillow 2. superior knee and hip flexed maximally and held with pt
hand 3. pt flexes cervical spine 4. Therapist then passively flexes the patients knee and
extends the hip
• Structural Differentiation• release of cervical flexion with no change in thoracolumbar
position
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Saphenous Nerve Test
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Saphenous Nerve Test
• Indications• groin pain • medial knee pain
• Areas of palpation• posterior to tibial plateau??
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Saphenous Nerve Test• Sequence
1. Pt is prone 2. knee extension 3. Hip extension 4. Plantarflexion/Eversion
• Sensitizing Movement• Internal rotation of the hip • Contralateral lateral flexion of the lumbar spine
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Obturator Nerve Test
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Obturator Nerve Test
• Indications• groin pain • pelvic pain
• Areas of palpation• unlikely
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Obturator Nerve Test• Sequence
1. Pt is in slump position straddling corner of table 2. neck flexion 3. hip abduction to end range
• Structural Differentiation• release neck flexion
• Sensitizing Movement• contralateral lateral flexion of the lumbar spine
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Central Based Tests
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Passive Neck Flexion• Indications
• Spinal pain (cervical, thoracic, lumbar) • Clearing test for progression to slump test? • Addition to bilateral SLR, slump test
• Sequence• Passively flex the patients cervical spine • Stabilize the patients thorax through the sternum
Keep in mind the previous slides re: convergence of the nervous system with spinal movement
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Bilateral SLR
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Bilateral SLR
• Indications• symmetrical or central spinal pain • examine the effect of caudad displacement of the spinal
neural elements
• Sequence• Passively flex the patients hips at the same time • Stabilize the knee to prevent flexion
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Bilateral SLR
• Structural Differentiation/Sensitizing Movement• bilateral dorsiflexion
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Slump Test
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Slump Test
• Indications• assess the dynamics of the central and peripheral nervous
tissue • symptoms at most anywhere (typically spine and LE)
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Slump Test• Sequence
1. Patient sitting (knees in front of hips) 2. thoracolumbar slump (maintain sacral angle) 3. Cervical flexion 4. Knee extension 5. Dorsiflexion
• Structural Differentiation• release neck flexion - distal symptoms • release dorsiflexion - proximal symptoms
• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • hip IR/add • specific foot movements for each nerve mentioned
previously