CNE Flashcards
QST
Circumferential
⚬soft touch
￭with a cotton ball or a very soft brush
⚬pin prick
￭with a toothpick or flagged pain
⚬several levels in affected area;
⚬Compare with unaffected side/area
Thermal detection testing in most painful area –
⚬two big coins or pieces of metal
￭Desk temperature vs Pocket temperature
￭in colder times/aircon;
or
￭desk temperature vs fridge temperature in warmer times, no aircon in room.
⚬About 8C with 20*C
C1
S: Forehead
M: Upper Cx flex
C2
Vertex, back head,
mandibular angle, lateral
neck
Upper Cx ext
C3
Occipital area, lateral neck & throat
Cx lateral flex
C4
Yolk area to deltoid
Shoulder girdle elevation
C5
*Ant-inf to deltoid insertion.
Radial forearm to wrist
Shoulder abduction
Biceps
C6
- Thumb tip.
Radial side of wrist
Elbow flexion
Biceps
C7
*Index finger tip.
Middle finger tip.
Elbow extension
Triceps
C8
*F5 tip & side.
Ulnar side of hand
Finger flex or thumb ext
T1
*Ulnar forearm at elbow.
Ulnar forearm to wrist
Finger add with IP ext, MP
flex
T2-12
Along ribs around trunk
to ant
L1
*distal to groin ant/med
thigh.
Med thigh
L2
*Ant/lat upper middle thigh
Hip flex @ 90⁰
L3
*Lower med thigh close to knee.
Below or above signature zone.
Knee ext – position in 30⁰ short of full ext
Patella tendon
L4
*Between med foot & big toe.
Medial foot & big toe.
Ankle DF/inversion (hold in mid-inversion)
Functional: heel walking
Patella
tendon
L5
*Dorsum 2nd toe.
Big toe, tips middle 3 toes, ball of foot.
Big toe extension (ankle in max DF)
Functional: heel walking
S1
*Dorsum small toe.
Lat side foot, heel of foot
Eversion (heels together), hip
extension, knee flexion
Achilles tendon
S2
*Middle post thigh below gluteal fold.
Post thigh, post upper calf
Ankle planter flexion
Functional: heel raises or toe walking
Achilles tendon
Plantar/Babinski reflex
sharp object strokes the lateral side of foot
while observing the
toes. Normal response = all toes do PF. Abnormal / + response = DF of big
toe and downwards fanning
of other toes.
Clonus
sustained TA stretch by performing quick, sharp DF (with
straight knee) . + response =
intermittent muscle contraction & relaxation when sustained.
Upper Limb Neurodynamic Test 1 (ULNT1)
MNT1/ULDT1- Median Nerve Test
- Shoulder stabilized in neutral
- Abduction (90º - 110º)
- Elbow 90º
- Shoulder Lateral rotation
- Forearm supination
- Wrist & finger extension
- Elbow extension
- Cervical Lateral flexion away/cervical lateral flexion towards
- Alternative sequencing
ULNT 1 normal response?
- Deep stretch cubital fossa
- Tingling in thumb & first three fingers
- Stretch ant. shoulder (small percentage)
- LF away increased response in 90%
- LF towards decreased response in 70%
ULNT 1 Clinical – Lesion Median Nerve
- Weak pronation of the forearm
- Weak flexion & radial deviation of wrist
- Thenar atrophy & inability to oppose or flex the thumb
- Sensory distribution includes thumb, radial 2 1/2
fingers, and corresponding portion of palm
ULDT 2a/MNT2
Median Nerve Bias
- Shoulder girdle depression
- Elbow extension (maintain in neutral plane)
- Whole arm lateral rotation
- Wrist & finger extension
- Shoulder abduction if necessary
- Differentiate – release shoulder depression/ wrist &
finger extension - Cx Lateral Flexion away or towards as sensitising
ULDT2b/RNT
Radial Nerve Bias
- Shoulder Girdle depression
- Elbow extension
- Whole arm internal rotation
- Wrist pronation
- Wrist flexion (tuck thumb in)
- Abduction (if necessary)
- Differentiate – release shoulder depression / finger
flexion
ULDT 3/UNT
Ulnar Nerve
- Shoulder girdle depression
- Wrist & finger extension
- Forearm pronation
- Lateral Rotation
- Elbow flexion
- Shoulder abduction
Clinical – Lesion (Ulnar)
- “Claw-like” deformity (in severe cases)
- Difficulty moving the fingers
- Wasting of the hand muscles (in severe cases)
- Weakness of hand flexing
Passive neck flexion
- Patient lies on their back with their head on a small
pillow. - Patient actively performs deep neck flexion.
- Therapist places their caudal hand over the patient’s
sternum to prevent movement. - Therapist places their cephalad hand under the
occiput of the patient’s head and passively flexes the
cervical spine. - A positive test is reproduction of THEIR pain.
- A pulling sensation is normal
Sensitisation tests in SLR
Tibial Nerve
* SLR
* Dorsiflexion/ eversion
Peroneal Nerve
* SLR
* Plantar flexion / inversion
Sural Nerve
* SLR
* Dorsiflexion/inversion
Slump
- Edge of plinth with hands behind back
- Slump shoulders to hips
- Neck flexion
- Knee extension non-symptomatic side
- Knee extension symptomatic side
- Dorsi-flexion first one side then other
- Release neck flexion as differentiation
- Can be active or passive
