NUERODYNAMIC TESTING

Question 1

Points for a straight leg raise

Answer 1

Unaffected side first perform a SLR
Note the range, quality and limiting factors
Normal response = pain and stretch
Positive = provoke symptoms

Question 2

Sensitising manoeuvres for straight leg raise

Answer 2

Medial rotation of hip - increases effects in sciatic nerve
Addiction of rotation of hip - increase effects in sciatic nerve
Passive neck flexion - increases effects in spinal cord
Ankle dorsiflexion with eversion - increases effects in tibial nerve
Ankle DF with inversion - increases effects in sural nerve
Ankle PF with inversion - increases effects in common peroneal nerve

Question 3

Points for passive neck flexion test

Answer 3

Patient supine, legs together
Passively flex patients cervical spine
Note range quality and limiting factors
Normal = pain free ROM
Positive = provocation of symptoms

Question 4

Sensitising manoeuvres for passive neck flexion

Answer 4

Straight leg raise - increase spinal cord effects
ULT tests

Question 5

Points for prone knee bend test

Answer 5

Side lying offers more sensitising options
Unaffected side is led in and client holds tibia in full hip flexion
Affected side does passive hip extension with full knee flexion
If symptoms are produced patient is asked to extend their neck and if symptoms ease the test is positive

Question 6

Sensitising manoeuvres for prone knee bend test

Answer 6

Hip extension increase effects on femoral nerve
Add slump to increase spinal cord effects

Question 7

Points for a slump test

Answer 7

Patient sits well back on plinth
Patients hands clasped behind back
Asked to slump, no hip flexion - stop test here if symptoms are reproduced
Add over pressure to flex spine and gently add over pressure on cervical spine
Extend a knee
Dorsiflex ankle on side being tested
Release neck flexion and note response

Question 8

Sensitising manoeuvres for slump test

Answer 8

Ankle dorsiflexion:
With eversion - increase effects in tibial nerve
With inversion - increases effects in sural nerve
Ankle plantarflexion with inversion increases effects in common personal

Question 9

Points for Upper limb tension test 1
Median nerve bias

Answer 9

Stabilise scapula to prevent shoulder girdle elevation
Abduct GH to 90
Elbow flexed to 90
Supinate forearm, wrist finger extend
Laterally rotate shoulder
Extend elbow

Question 10

Sensitising manoeuvre of ULTT 1 median

Answer 10

Cervical side flexion or rotation away from arm being tested - brachial plexus nerve roots

Question 11

Points for ULTT 2a median

Answer 11

Stabilise shoulder girdle
Abduct and flex GHJ to 30
Flex elbow to 90
Then add elbow extension, lateral rotation of shoulder and supination of forearm
Add wrist finger and thumb extension
Add shoulder abduction

Question 12

Sensitising movements of ULTT 2a

Answer 12

Cervical side flexion or rotation away from arm being tested increases brachial plexus nerve roots

Question 13

Points for upper limb tension test 2b radial nerve bias

Answer 13

Stabilise shoulder girdle
Abduct shoulder to 10
Extend elbow
Medially rotate GHJ and pronate forearm
Flex wrist and fingers

Question 14

Sensitising manoeuvres for ULTT 2b

Answer 14

Cervical side flexion or rotation away from arm being tested increases brachial plexus
Shoulder girdle protraction sensitises the suprascapla nerve

Question 15

tips for ULTT 3 ulnar nerve bias

Answer 15

Abduct shoulder to 10 and flex to 30
Flex elbow to 90
Extend wrist and fingers
Fully flex elbow
Laterally rotate shoulder and probate forearm
Abduct shoulder to 90

Question 16

Sensitising manoeuvre for ULTT 3

Answer 16

Cervical side flexion or rotation away from arm being tested - brachial plexus

Question 17

What is Nuero dynamic testing

Answer 17

Assesses the mobility of the nervous system and ability of neural system to adapt to body movements

Question 18

What flags are there in patient assessment to perform Nuero exams

Answer 18

Sensory changes - radiation of numbness, tingling, shooting pains
Weakness
Paralysis

Question 19

What is the AIM of neurodynamic testings

Answer 19

To differentiate between a CNS lesion or a peripheral nerve problem

Question 20

What do nuerodynamic tests ASSESS

Answer 20

Loss of conduction - any weak or absent reflexes, any muscle weakness or any reduced sensation

Pain and sensitivity - hyperflexia, muscle spasms, alloydnia, increased sensitivity to mechanical load

Question 21

How do we assess pain and sensitivity for neurological testings

Answer 21

1. Nuerodynamic tests
2. Palpation
3. Tinels sign
4. Nueral compression tests

Question 22

How do we test sensation

Answer 22

DERMATOME TESTINGS

Skin sensation tests, ask patient to close eyes and conduct the test using cotton wool
Cover the whole upper and lower body, comparing affected and unaffected side, map out any areas of altered sensation

Question 23

How do we test reduced motor impulses along nerves

Answer 23

MYOTOME testing
Muscle strength tests, indicate nerve root problems which may affect the muscles supplied
To test = complete an isometric muscle test mid range
Graded by the MRC scale (Oxford grading scale)

Question 24

What are reflexes
What do reflex tests do and what do they show

Answer 24

The simplest nueral pathway involving a sensory nerve and a motor nerve with a synapse between

Deep tendon reflexes test the integrity of the spinal reflex arc
Extreme nerve root compression results in the abscence of reflexes, mild compression may be a diminished reflex
Upper motor neurone lesion may result in an increased reflex response

Question 25

What are the reflex test responses

Answer 25

0 = absent - not muscle contraction
1 = diminished - slow reaction
2 = normal
3 = increased - quick or exaggerated
4 = brisk / Clonus

Question 26

What is a clonus response from a relfex test

Answer 26

An exaggerated relflex, intermittent muscle contractions and relaxations
Suggests an upper motor neurone lesion

Question 27

What test should be conducted from a clonus response and indication of upper motor neurone lesions

Answer 27

BANINSKI RESPONSE
stroking the lateral aspect of the foot and observe movements of the toes
Normal response = all goes to flex
Abnormal response = dorsiflexion of the big toe and downward fanning of the remaining toes

Question 28

When do we carry our neurodynamic tests

Answer 28

After myotomes, dermatomes and reflex tests and any have been positive, highly irritiable or neurological signs are deteriorating

Question 29

Contraindications to neurodynamic tests

Answer 29

RA
severe osteoporosis
Suspicion of metastasis
Cauda equina signs
Severe neurological signs

Question 30

Precautions to neurodynamic testing

Answer 30

Acute nerve pain - highly irritable
Age of presentation (care <20 >55)
Unrelenting progressive non-mechanical pain
Night pain
Recent wieght loss
Osteoporosis
Violent trauma
Thoracic pain
Morning stiffness
Peripheral or spinal joint stiffness
Family history of spondyloarthropathy