L12: Skills Prac 5-6

Question 1

What are indications of the neurological examination?

Answer 1

1. Patient’s reporting pain referred distal to the tip of the shoulder
2. Any reports of paraesthesia, anaesthesia

Question 2

What are 3 clinical pointers of the neurological examination?

Answer 2

1. Muscle tests: build up resistance slowly to avoid pain inhibition
2. Sensation testing: Always compare to non affected side
   
   1. Must be pain-free
   2. Isometric muscle test (not full range)
   3. (quite sensitive)
3. Reflexes: ‘drop’hammer rather than hit
   
   1. (quite sensitive)

Question 3

What is the neurological exam like?

Answer 3

Sensation:

• Does this feel the same as this side?

Muscle test

• C4: Shoulder shrug
• C5: Abduction
• C6: Biceps (elbow flexion)
• C7: Tricpes (elbow extension)
• C8: Thumb extension (ext pollicis longs

Reflexes

• Drops on thumb (not directly on patient)

Question 4

What are 6 clinical pointers of Neural Tissue Provocation Tests for the cervical region?

Answer 4

1. Always conduct NTPT with due caution and respect to mechanosensitive nerve tissues
2. Take the test to P1 only (iethe first reproduction of pain)
3. If paraesthesia is reproduced, relieve provoking position
4. End feel will be muscle guarding
5. Confirm the cause of the limitation is nerve tissue in origin by adding and subtracting sensitising movements (Cranio-cervical flexion, Cervical lateral flexion; altering wrist and finger position)
6. If you perceive that the patient is holding actively, convert the test to an assisted active test

• “I’m going to examine the nerves in your arm in a series of manoeuvres (one test after another). We want to see if that has any effect on the pain. Now if we produce any pain, I’m going to let the pressure off a bit to get you to do a LF movement with your head to one side and we are going to see if it makes any difference to the sensation.”
• Teach LF away /towards (OFF or ON)

Question 5

When can you introduce neurodynamic tests?

Answer 5

When severe pain has settled and condition is less irritable can gradually introduce neurodynamictests

• Since it is highly provocative, only do if pain is not severe.

Question 6

What happens when the neurological examination is clear?

Answer 6

• If neurological examination is clear, may use distal components to test
• Tests are provocative so proceed with caution