Compression Neuropathy Lab Flashcards
Bilateral UE weakness DDx
- Spinal cord
- Peripheral neuropathy
- Systemic (electrolyte abnormality)
Unilateral weakness in 1 limb DDx
-
Localized region of a limb
- Mononeuropathy
- Radiculopathy
- Plexopathy
-
Entire limb
- Plexopathy
- Central lesion
- Sx of radiculopathy
- Objective
- S:
- Pain in the neck that radiates down the arm to a specific region in hand due to impingement of nerve at cervical spine (disc disease, herniation, degenerative arthritis)
- O
- numbness
- weakness along distribution
- decreased reflex (dep on what cervical level affected)
What is the first test we run if we suspect radiculopathy and why?
+ spurlings; CHEAPER than MRI and EMG
Diagnosing radiculopathy
- Diagnose:
- OA (for SB/translation)
- ex OA F SrRl
- AA (rotation only by FULLY flexing!)
- AA Rr
- C2-C7
- OA (for SB/translation)
Treatment for radiculopathy
- Cervical: contralateral traction (ST)
- Cervical subocciptal release (ST)
- Cervical: unilateral forearm fulcrum bending
- Cervical: bilateral forearm fulcrum bending
- OA MET
- AA MET
Symptoms of a plexopathy?
- Intermittant numbness and tingling NOT consistent w 1 nerve root
- Pain in neck/shoulder
- Generalized, intermittant weakness of extremity
Speciality tests for plexopathy and what they indicate is causing the compression
-
EAST
- general
-
Adson
- Scalene muscles
- 1st rib
- Cervical rib
-
Military brace
- Clavicle
-
Wright
- Pec minor
Treat plexopathy (+ Adson test => 1st rib)
- Inhalation SD MET
- Exhalation SD MET
Treat plexopathy (+ Military brace => clavicle)
- Clavicle SC Elevated/adducted SD; MET
- Clavicle SC Horizontal extension SD; MET
- Clavicle AC IR SD; MET
4.
Treat plexopathy (+ Wright test=> Pec minor)
-
Pec minor counterstrain (f-F ADD)
- Pt lays on back; doc on opp or same side
- Contact pec minor TP:
- inferomedial to coracoid process
- f-F ADD
- Adduct patients arm across the chest , pulling shoulder anterior
- Hold for 90 seconds and return to neutral
Name 3 mononeuropathies
- Pronator teres (median n entrapment)
2. Carpal tunnel (median n entrapment)
3. Cubital tunnel (ulnar n entrapment)
Pronator teres syndrome
S:
O: (+ speciality test, sensation, reflexes)
- S
- Numbness/tingling of forearm => wrist => first 3 fingers of the hand
- Weak grip
- O
- phalen/ OK test/ Tinels sign at wrist (all test median N)
- Restisted pronation test
- Decreased sensation
- NL reflexes
What specialty tests test median N?
-
Phalens
- put dorsal parts of hands together => wrist flexion for 60 sec
- +; paresthesia in distrib on median n => carpal tunnel
-
Ok test (anterior intereouss branch => +; anterior interosseous nerve palsy)
- Make a ok sign with both hands
- +: one hand makes a pinched circle (DIP joint on index finger is extended, not flexed) => anterior interosseous palsy
-
Tinels sign @ wrist
- Tap on transverse carpal L (between thenar/hypothenar em) while patients hand is extended
- + pain/numb/tingling to medial nerve distribution (thumb, index and 1/2 of 3rd finger) => carpal tunnel (median n. entrapment
OMT for pronator teres syndrome
-
Pronator teres counterstrain (F PRO Add)
- Pt lays on back; doc on same side
- Find TP: near medial epicondyle
- F PRO Add
- Flex and pronate elbow (palms face floor); adduct
- Hold for 90seconds => neutral
Carpal tunnel syndrome
Subjective:
O: (speciality tests, sensation, reflexes)
- S
- Wake up at night with wrist pain and numb/ting in first 3.5 fingers
- Day: pain is intermittant and dull/achy
- O
- Phalen/ prayer/ OK/ Tinnel test
- Decreased sensation
- NL reflexes
+ special tests for carpal tunnel
- Phalens
- Tinels
- OK
- Prayer
OMT for carpal tunnel
- Wrist extension carpal SD; HVLA
- Wrist flexion carpal SD; HVLA
- Wrist: isotonic MET
- Wrist: flexor retinaculum MFR
- Wrist: figure 8; ART
Name SD if this is hard
Wrist flexion SD (likes to flex, cant extend)
Name SD if this is hard
Wrist extension SD (like to extend, cant flex)
Pic if flexing wrist
Name SD if this is hard
Name SD if this is hard
Cubital tunnel syndrome
Subjective
Objective (sp tests, sensation, reflexes)
- S
- Numbness and pain from medial forearm => 4th/5th fingers
- O
- Tinnel posterior/superior to elbow/ + Froments
- Decreased sensation
- NL reflexes
Speciality tests for ulner nerve palsy
-
Froments sign
- Tell pt to pinch piece of paper with [thumb and index finger] while doc pulls on paper.
- test: IP joint of thumb flexes => ulnar nerve palsy/weak ADDUCTOR POLLICIS
- Tinels test at elbow
SD for cubital tunnel syndrome (not on CPA)
- Elbow extension/flexion SD
- Elbow adbuction/adduction SD
S: His new job is warehouse stocking for a local distribution company that involves lifting and moving heavy boxes. Numbness is limited to the right gluteal region, but he has paresthesia and dysesthesia that travels from the right buttock to the right foot on the posterolateral aspect of the leg.
What is this? Keys?
S: His new job is warehouse stocking for a local distribution company that involves lifting and moving heavy boxes. Numbness is limited to the right gluteal region, but he has paresthesia and dysesthesia that travels from the right buttock to the right foot on the posterolateral aspect of the leg.
- Herniated disc (lumbosacral radiculopathy; L5-S1)
- In lumbosacral radiculopathy, ____ is the most common affected segment, most commonly due to _________.
- Symptoms?
- L5-S1; herniated disc
- Pain from butt => radiates => posterolateral ankle or foot
Red flag symptoms of lumbosacral radiculopthy
- WL
- Fever
- Chills
- Loss of bowel or bladder control
Posterior pelvic, lumbar and sacrum TP
-
UP L5
- superomedial surface of PSIS
-
LP L5
- Inferior to PSIS, pressing superior
-
PL3 gluteus
- 2/3 lateral from PSIS to tensor fascia lata
-
PL4 gluteus
- Posterior part of TFL
Lumbar: Upper Pole L5 (UPL5), Counterstrain
- Doc on same or opp side
- TP: superomedial border of PSIS
- E Adduct IR/ER
Lumbar, Lower Pole L5 (LPL5), Counterstrain
- Doc sitting on same side of TP
- Pt: on stomach of thigh hanging off
- TP: Inferior border of PSIS
-
F IR Adduct
- flex hip to 90
- adduct knee and IR
High Ilium Sacroiliac (HISI), Counterstrain
- Stand on same side as TP
- Pt on stomach
- TP: 2-3cm lateral from TP
- e-E Abduct ER
Lumbar: Type 1 (Neutral) SD, Long Lever Lateral Recumbent, MET
- Doc: face pt; monitor with cephalad hand
- Pt: LR; PTP up
- NUDR
- Neutral
- PTP UP
- pt force DOWN
- Recumbant
- Tech
- Flex hips and knees until motion is felt uner hand
- Lift patients ankles (SB spine into barrier)
- Pt pushes ankles down against docs counterforce for 3-5 seconds
- Pt relaxes => bring to next barrier
- Repeat 3-5x until no restriction
Lumbar: Type 2 (Extended) SD, Long Lever Lateral Recumbent, MET
Doc: face pt; monitor with cephalad hand
Pt: Modified SIM- chest to bed; PTP up
SUUE
- Sims
- PTP UP
- pt force UP
- Extension
Tech
- Flex hips and knees until motion is felt under hand
- Drop pts legs off table
- Pt raises ankles up to ceiling against docs counterforce for 3-5 seconds
- Pt relaxes => bring to next barrier
- Repeat 3-5x until no restriction
Lumbar: Type 2 (Flexed) SD, Long Lever Lateral Recumbent, MET
Doc: face pt; monitor with cephalad hand
Pt: LR; PTP down
FDDR
- Flexed
- PTP down
- pt force down
- Recumbant
Tech
- Lean back back
- Straighten bottom leg; flex top hip and lift ankle
- Pt pushes down to floor against docs counterforce for 3-5 seconds
- Pt relaxes => bring to next barrier
- Repeat 3-5x until no restriction
S: His new job is a long haul trucker. His pain is located in his right gluteal region, but has dysesthesia that travels down the back of his thigh to his right knee. You notice that he has a worn square imprint of his wallet in the right back pocket of his jeans.
What is this?
S: His new job is a long haul trucker. His pain is located in his right gluteal region, but has dysesthesia that travels down the back of his thigh to his right knee. You notice that he has a worn square imprint of his wallet in the right back pocket of his jeans.
Piriformis syndrome:
Important to rule out true sciatica due to _________ (need imaging studies)
lumbar disc herniation
Sx of piriformis
- Pain sitting, standing or lying longer than 15-20 min
- Pain/paresthesia from [sacrum => gluteal area => posterior thigh => stops above knee]
- CONTRALATERAL SI pain
- Weak IPSILATERAL LE
- Diff walking (foot drop)
OMT for piriformis syndrome
- Piriformis counterstrain (F abd ER)
- Supine self-stretch
- Piriformis MET
History reveals that he has paresthesiasand numbness over the anterolateral aspect of his left thigh with no other radiation. His new job as a security officer makes him wear a utility belt to work and he’s very stationary inside a booth which has caused him to gain a lot of weight. This is evidenced by extra abdominal adipose tissue that lays down over the top of his pants.
What is this?
History reveals that he has paresthesias and numbness over the anterolateral aspect of his left thigh with no other radiation. His new job as a security officer makes him wear a utility belt to work and he’s very stationary inside a booth which has caused him to gain a lot of weight. This is evidenced by extra abdominal adipose tissue that lays down over the top of his pants.
- Meralgia PAresthetica (lateral femoral cutaneous N entrapment)
Speciality test for meralgia paresthetica
+ tinels sign 1cm inferior and medial to ASIS
Meralgia Paresthetica Treatment
- Behavioral model
- Biomechanical
- Behavioral model
- wear looser clothes
- lose weight
- Reassurance its not serious
- Biomechanical
- Treat SD of psoas, sacrum, innominate, anterior thigh muscles
- Local MFR to abdoment
- L2-L3
S: The pain is actually numbness and paresthesia that occurs over the lateral aspect of his lower leg and the dorsum of his left foot. He was recently hired as a meditation coach and now spends hours each day with his legs crossed
S: The pain is actually numbness and paresthesia that occurs over the lateral aspect of his lower leg => dorsum of his left foot. He was recently hired as a meditation coach and now spends hours each day with his legs crossed
Common fibular nerve neuropathy
Sx common fibular N neuropathy
-
Numbess/paresthsia [lateral aspect of lower leg => dorsum of L foot]
- Pain is due to etiology; traumatic compression is painful, not crossing legs
-
Legs crosses
- not painful
-
Foot drop
- weak dorsiflexors
S: He has recently began working as a hospital chaplain and is continually walking around the hospital. The pain is limited to the plantar aspect of his right foot. He has flat feet with almost no longitudinal arch.
- Tarsal tunnel syndrome: compression of posterior tibial nerve behind medial mallelous and flexor retinaculum => non-specific pain on plantar surface of foot.
- gait is not usually affected
OMT for Tarsal Tunnel Syndrome
- Calcaneus HVLA: inversion/eversion SD
- Talus Tug HVLA: plantarflexed/dorsiflexed SD
- Gastrocnemius Counterstain (plantarflexion)
- TP: proximal gastroc muscle belly
- Position: F Abduct ER
- Ankle Figure 8, ART
