Ortho 2 (special tests/glides): TMJ, neck, VAT, cranial nerves and dizziness, ULNT's/SLR Flashcards
Dental occlusion assessment
slides 1-32
Cx spine ROM flex, ext, SF, ROT
last semester
ms flexibility/palpation of upper traps, scalene, SCM
last semester
TMJ ROM opening, closing, protraction, retraction, lateral deviation
slides 34-51
TMJ RISOM opening, closing, protraction, retraction, lateral deviation
slide 52
TMJ palpation - lateral pole, condyle
TMJ passive accessory glides (inf/ant)
slides 65-67
Outside technique: Pht place thumb on body of mandible
tectorial membrane ligament stress test
TMJ palpation - temporalis
TMJ palpation - masseter
TMJ palpation - Posterior & sub-mandibular muscles
TMJ palpation - lateral pterygoid
TMJ palpation - medial pterygoid
transverse ligament stress test
alar ligament stress test
Anterior & Posterior atlanto-axial membranes stress test
vertebral artery testing
Contraindication to testing VA:
- VBI &/or SC S&S on S/A or first part of dizziness protocol
- Trauma < than 6 weeks
- Cr-Vx lig stress test = (+)ve
- Fracture or risk of fracture
Need 45° of rotation to cause blood flow disturbance & at least another 10-15° to have complete obstruction.
Pht must recognize the potential for obtaining false (-)ve
Neuro exam for cranial nerves
see slides 20-32
dizziness differentiation tests
ULNT1
Move almost all the nerves btw neck & hand – median, radial & ulnar n, brachial plexus, spinal ns & Cx n roots
Indications:
- Should be performed when a neural component to U/Q pain/sy is present or when pht want to exclude a neural component
- This test is particularly relevant in cases where symptoms are localized to the median nerve
Good inter & intra reliability
Normal Responses:
- Similar areas of response in both ULNTs
- Sensory response was more frequent in ULNT2m than ULNT1
- The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1
ULNT2m
It Ax the median n, brachial plexus, related spinal ns & low Cx n roots
Indications:
- When pt’s symptoms are provoked by scap depression
- Symptoms are localized to the median nerve
- Can be used in preference to the ULNT1 when shoulder problem & want to avoid abd
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Releasing scapula depression or
- Wrist flexion
Normal Responses:
- Similar areas of response in both ULNTs
- Sensory response was more frequent in ULNT2m than ULNT1
- The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1
ULNT2r
Indications:
- This test is particularly relevant in cases where symptoms are localized to the radial nerve
- Posterior shoulder pain
- Lateral elbow pain
- Dorsal F/A pain (radial tunnel syndrome, de Quervain’s disease)
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Release a small amount of pressure from scapula depression or
- Wrist extension
Normal Responses:
- Posterior/lateral FA & wrist deep pain/stretch
- Painful stretch post aspect of hand, lat arm & biceps
ULNT3
Indications:
- This test is particularly relevant in cases where symptoms are localized to the ulnar nerve
- Anterior shoulder
- Axilla
- Along the medial aspect of the arm & elbow to the hypothenar eminence & 4-5th fingers
- C8 radiculopathy
- TOS
- CuTS
- Guyon’s canal syndrom
Distal Manoeuvre:
- Cx spine ipsilat side flex or
- Release a small amount of pressure from scap depression or
- Wrist flexion
Normal Responses:
- Stretch sensation in almost any region of the upper limbs
- But more common in ulnar distribution
- P & N and burning sensation can also occur
sciatic nerve neuromeningeal testing
tibial nerve neuromeningeal testing (tibial branch)
tibial nerve neuromeningeal testing (tibial branch)
fibular (peroneal) nerve neuromeningeal testing
sural nerve neuromeningeal testing
