Lecture 1: UQ Scan Flashcards
flattened deltoid + history of GH dislocation
makes you think… increased concern for ____
axillary nerve palsy
What is regional interdependence?
happens more in UQ than LQ
seemingly unrelated impairments are associated w/ patient’s pain, maybe mediated due to central mechanisms
Impairment/Regional Interdependence model
MSK impairments (pain, ROM
neurophysiologic
biopsychosocial
somatovisceral: referred/radicular pain
lateral elbow pain is associated with
cervical
shoulder
wrist/hand impairments
LBP is associated with ___ impairments
PFPS is associated with _____ impairments
LBP: hip
PFPS: LBP, hip, foot, ankle
T-spine manips (HVLAT) are shown to
___
____
____ outcomes in patients with RC tendinopathy, adhesive capsulitis
decrease c-spine pain
increase Lower trap strength
improve RC, frozen shoulder outcomes
What is impacted with chronic neck pain?
neck
ST
shoulder
hip
trunk (abs, erectors)
EVERYTHING
Why do scanning exams?
Refer, refer and Rx, Rx
narrow source of symptoms
examine neuro
identify primary impairments
improve rehab outcomes
3 reasons to scan or not
- no obvious MOI
- proximal cause for distal symptoms
- sounds MSK or not
components of the UQ scanning exam
- observation
- history (systems review, medical screen)
- c-spine AROM + overpressure
- UE ROM
- myotomes
- dermatomes
- compression/distraction
- ULTT1
- DTRs
- pathological reflexes
- palpation
difference between review of systems and systems review
ROS: collect info about each body system, does it need an exam?
systems review: hands on component
causes for nausea, vomiting
metabolic, CV, liver
pregnancy
meds
increased ICP, HA, Hemmorhage
causes for paresthesias, numb, weak
renal, endocrine
adverse drug reactions***
progressive neuro loss
negative coping skills, anxiety, depression, kinesiophobia, dizziness, abnormal sensory patterns, progressive weakness, fainting, circulatory or skin changes
what flag is this?
yellow
In 1 LBP research study, __% pf pts w/ LBP had 1 red flag, but <1% actually had a serious disease/pathology
80%
myotome screen:
shoulder abduction
mm tested:
root level:
peripheral nerve:
mm tested: DELTOID
root level: C5
peripheral nerve: AXILLARY
myotome screen:
elbow flexion
mm tested:
root level:
peripheral nerve:
mm tested: BICEPS
root level: C6
peripheral nerve: MCN
myotome screen:
elbow extension
mm tested:
root level:
peripheral nerve:
mm tested: TRICEPS
root level: C7
peripheral nerve: RADIAL
myotome screen:
wrist extension
mm tested:
root level:
peripheral nerve:
mm tested: ECRL, ECRB, ECU
root level: C6
peripheral nerve: RADIAL
myotome screen:
wrist flexion
mm tested:
root level:
peripheral nerve:
mm tested: FCR, FCU
root level: C7
peripheral nerve: MEDIAN-FCR, ULNAR-FCU
myotome screen:
finger flexion
mm tested:
root level:
peripheral nerve:
mm tested: FDS, FDP, lumbricals
root level: C8
peripheral nerve: median FDS, median+ ulnar FDP, lumbricals
myotome screen:
finger abduction
mm tested:
root level:
peripheral nerve:
mm tested: DABs (dorsal interossei)
root level: T1
peripheral nerve: ulnar
median nerve is responsible for…what mm actions?
wrist flexion
finger flexion
radial nerve is responsible for…
elbow extension
wrist extension
___ nerve innervates both elbow and wrist extension, while C__ provides input only to elbow extension
radial nerve
C7: elbow ext only (and wrist FLEXION)
lateral volar side of forearm tests __ but not the __nerve
palmar side of thumb tests both __ and ___ nerve
lateral volar side of forearm tests C6, but not the median nerve/palmar side of thumb tests both C6 and median nerve
Pain reproduced w/ compression suggests:
Disc herniation
Vertebral end plate fx
Vertebral body fx
Acute arthritis/joint inflammation
Nerve root irritation (if radicular symptoms produced–> usually shoot below elbow)
Pain reproduced w/ distraction suggests:
Spinal ligament tear
Tear/inflammation of annulus fibrosis
Muscle spasm
Large disc herniation
Dural irritability (if non-radicular arm pain produced–> usually do not go past elbow)
+ ULTT
- side to side differences
- reproduction of their pain
- distant component increases pain
Which pulses do you need to take if you suspect vascular involvement?
carotid
brachial
radial
ulnar
0-4, 3 is normal
nerve tissue responds to movement by:
gliding
lengthening
compression
3 tension sites where dura is tethered to bony canal
C6
T6
L4
ULTT1
median nerve
3 or more ULTT positive
rules in cervical radiculopathy
all negative ULTT
rules out cervical radiculopathy
