Compression Neuropathy lab & HYHO Flashcards
What would a (+) spurling test indicate?
radiculopathy
What tests can be used for plexopathy?
East/Roo
Adson
Military Brace
Wright
What does a (+) Adson test indicate?
scalene muscles or 1st rib/cervical rib causing compression neuropathy.
What is the difference between radiculopathy vs plexopathy vs mononeuropathy?
radiculopathy = localized region of one unilat limb experiencing symptoms due to nerve root impingement (disc herniation, etc) plexopathy = intermittent symptoms inconsistent with one nerve root due to brachial plexus (or other plexus) impingement mononeuropathy = compression at one nerve usually within the extremity (ie carpal tunnel syndrome)
lumbosacral radiculopathy most common effected segment and most common etiology?
L5-S1
herniated disc
lumbosacral radiculopathy pain distribution?
frequently lead to pain down one leg from the butt to the foot.
WATCH FOR RED FLAGS: weight loss, fever, chills, loss of bowel or bladder control
What is piriformis syndrome? classic presentation?
sitting on a wallet for a long time.
mononeuropathy where the sciatic nerve is pinched by the piriformis muscle.
pain with sitting/standing longer than 15-20min, pain radiating from sacrum through butt and down posterior thigh (will stop above the knee). may have foot drop/weird gait, numbness in 1 foot, ipsilateral LE weakness
Spurling’s maneuver
seated or supine. Dr ex/rot pt head to one side and pushes down for 1 min. do bilat
(+) = reproduction of pain, paresthesia
COMPRESSED CERVICAL NERVE ROOT IPSILAT
Straight leg raise
one leg passively flexed with knee extended. do bilat.
(+) = pain/repro symps bw 35-70deg
COMPRESSED LUMBOSACRAL NERVE RT
Apprehension test
shoulder abd to 90 elbow flexed to 90 force into external rotation.
(+) = pt apprehension
GLENOHUMERAL INSTABILITY
sulcus sign
pull arm down
(+) = indentation
glenohumeral instability
Yergason Test
palpate bicipital groove, supinate and ex rotate against dr resistance.
(+) = pain/subluxation out of groove
UNSTABLE BICIPITAL TENDON/SUBLUX
Adson Test
monitor pt radial pulse, extend arms, ext rot, abd at affected shoulder, apply cervical traction and rot toward affected side and INHALE = lots P.
(+) = repro symps or dec radial pulse
THORACIC OUTLET SYNDROME
Military Test
monitor pt radial pulse, extend arms, ext rot, abd at affected shoulder, pt sit or stand to “military attention” (retract scapula)
(+) = repro symps or dec radial pulse
THORACIC OUTLET SYNDROME
East/Roos Test
bilat shoulder and flex and ext rot all to 90. open and close repeated open and close
(+) = repro of symps/weakness/discolored hands
THORACIC OUTLET SYNDROME
Wright hyperabduction test
Start at roos positioning and then hyperflex while monitoring radial pulse
(+) = repro symps/ dec radial pulse
THORACIC OUTLET SYN DUE TO PECT MINOR
Tinel’s Sign at wrist
tap over transverse carpal L (bw thenar and hypothenar eminences)
(+) = parasthesias radiating to thumb/index/middle
MEDIAN NERVE ENTRAP. OR CARPAL TUNNEL SYN.
Phalen’s sign
put dorsal parts of pt hands together and force into wrist flex for 60s
(+) = parasthesis in median n
MEDIAN N TRAPPED. CARPAL TUNNEL SYN
OK test
have pt make ok sign
(+) = one had makes pinched circle instead of actual circle
ANTERIOR INTEROSSEOUS N PALSY
Froments Sign
pt pinch paper between thumb and index and pull paper.
(+) = thumb joint flex
ULNAR N PALSY, ADDUCTOR POLLICIS
How would treat a radiculopathy of the neck?
1) evaluate OA, AA, C2-C7 and diagnose
2) tx options:
contralateral traction cervical
suboccipital release
unilat forearm fulcrum forward bending
bilate forearm fulcrum forward bending
How can you diagnose and treat a first rib caused plexopathy?
dx: Adson test
tx: supine inhalation dysfxn MET
exhalation dysfxn MET
J-stroke HVLA
How can you diagnose and treat a clavicular caused plexopathy?
dx: miliary brace test
tx: SC horizontal extension SD MET
SC elevated/ADDucted SD MET
AC internal rot SD MET
AC external rot SD MET
How can you diagnose and treat a pectoralis minor caused plexopathy?
dx: wright hyperabduction test
tx: f-F ADD TP
What SD could a pronator teres mononeuropathy present as and how would you treat?
radial head pronated (posterior) SD
radial head supinated (anterior) SD
tx: F PRO Add TP
What tests would be positive for carpal tunnel syndrome?
Phalens, Prayer tests, OK test, Tinel test
What tests would be positive for pronator teres syndrome?
phalens, resisted pronation test, ok test
What SD could someone with carpal tunnel syndrome have?
wrist extension or flexed SD
wrist Add or Abd SD
How can you treat carpal tunnel with OMT?
figure 8 wrist articulation wirst isonotic MET (thumbs in x over thenar) wrist flexor retinaculum MFR wrist extensino/ventral carpal SD HVLA Wrist Flex/dorsal carpal SD HVLA
What tests would be positive for cubital tunnel syndrome?
tinel posterior/superior to elbow
froment’s test
decreased sensation/numbness medial forearm into the 4th and 5th digits
What SD could someone with cubital tunnel syndrome present with?
elbow extension/flex SD
elbow add/abd SD
where is the UPL5 located?
superior medial surface of PSIS
where is the LPL5 located?
on the ileum just inferior to PSIS press superior
where is the PL3 gluteus located?
2/3 lateral from PSIS to tensor fasciae latae
PL4 gluteus is located where?
posterior margin of tensor fasciae latae
How can you treat piriformis syndrome with OMT?
counterstrain F abd ER
Supine piriformis self-stretch
Piriformis MET
What OMT can you provide for pts with meralgia paresthetica?
Psaos, sacrum, innominate, anterior thigh SD
MFR to abdomen
L2-L3 focused treatments
what’s the most worrisome symptom to a patient with common fibular nerve syndrome?
foot drop
How can you treat common fibular nerve syndrome?
posterior fibular head MET
post fibular head HVLA
post fibular head BLT
how can you treat tarsal tunnel syndrome with OMT?
calcaneal HVLA
Talar tug HVLA
gastrocnemius CS plantarflex
ankle figure 8
