Trunk/Nerves Special Tests Flashcards
tectorial membrane ligament stress test
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
SI Joint - ASIS gap test
SI Joint - ASIS compression test
SI joint - thigh thrust
SI joint - Gaenslen’s test
SI joint - sulcus thrust
SI joint forward bending test
SI joint - standing flexion kinetic test
1) is for SI joint dysfunction
2) is for confirming SI hypermobility/instability
SI joint - ASLR
Lx spine - prone instability test
Pt: lays only half way up the bed, with the hips flexed, the trunk muscles relaxed & the feet resting on the floor
Pht: will do a PA over the most symptomatic SP If provocation of pain is reported….
Lx spine - active straight leg raise (basic scan)
Normal = optimal Lx-Sx functional load transfer
- Leg raised = effortless bilaterally
- Lx-Sx region = stable (no movt)
- Need good activation of IU & OU ms
Abnormal
- One leg: feels heavier to lift
- Lx-Sx region: unstable (movt in ext, flex, rotation, SF of spine)
Grading system (active leg lifting)
0= not difficult at all
1= minimally difficult
2 = somewhat difficult
3= fairly difficult
4= very difficult
5= unable to do
Optimal ASLR = the only joint moving is the hip & “it is not difficult at all”
Lx spine - ASLR testing inner unit muscle stimulation (3)
Lx spine - ASLR testing outer unit muscle stimulation - anterior sling
(+)ve test if applying compression(s) or activating sling(s) which:
- Makes it easier to lift the leg (affected)
- More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)
Meaning:
- When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
- Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
Lx spine - ASLR testing outer unit muscle stimulation - posterior sling
(+)ve test if applying compression(s) or activating sling(s) which:
- Makes it easier to lift the leg (affected)
- More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum)
Meaning:
- When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic
- Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax
Lx spine - assess transferse abdominal ms
Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction
Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally
Normal:
Able to activate IU ms alone
Deep, slow tension of IU ms
No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)
With IU ms activation should be able to breathe normally
Activation -10x10sec (Ax how many reps pt can do)
Abnormal: Substitution strategies
OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)
Bulging of abdomen (= Internal oblique ms contraction)
Depression rib cage (= rectus abdo ms contraction)
Hold breath
Not able to hold 10sec, 10x
**exercises slides 19/20
Lx spine - assess the multifidus ms
Pt: spine in neutral position
Pht: palpate IU ms
Ax IU ms activation (tension) without any OU ms contraction
Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally
Normal:
Able to activate IU ms alone
Deep, slow tension of IU ms
No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction)
With IU ms activation should be able to breathe normally
Activation -10x10sec (Ax how many reps pt can do)
Abnormal: Substitution strategies
OU ms contraction (causing post rot of pelvis, Lx spine flex/ext)
Ant rotation of pelvis, gripping of buttock ms (= OU ms contraction)
Hold breath
Not able to hold 10sec, 10x
Lx Spine - assess the pelvic floor ms
Lx spine - femoral nerve sheath mobility
Lx spine - supine TrA test
Lx spine - prone TrA test
Lx Spine - Anterior oblique sling Ax
Lx spine - prone hip extension
Ax the strength, control & firing pattern of the lumbopelvic stabilizers & hip extensor ms
- Pt in prone with a pillow under the pelvis (for neutral position of the spine)
- Pt is asked to lift a straight leg 8-10 inches off the table
Lx spine - posterior oblique sling - LAT DORSI ms strength
Lx spine sling Ax - Hip Abduction neuromuscular control test
Lx spine sling Ax - Glut medius Isometric (brake) strength test
Lx spine sling Ax - Glut medius ms strength – Trendelenburg test
Tx spine - how to do slump test
Tx spine - sitting arm lift (SAL) test
Part 2:
Pht:
-Thumbs on SPs & index fingers along the ribs
-Ask pt to repeat movt several times with arm that felt heavier to lift
-Palpates the ribs individually
(+)ve = rib translation or rotation
= lack of control of that segment = failed load transfer
Pht
- Stabilize the ring (segment) that was translating/rotating
- Ask pt to repeat sitting/prone arm lift with arm that felt heavier q Look for any changes in easiness to do the test
Tx spine - prone arm lift (PAL) test
Part 2:
Pht:
-Thumbs on SPs & index fingers along the ribs
-Ask pt to repeat movt several times with arm that felt heavier to lift
-Palpates the ribs individually
(+)ve = rib translation or rotation
= lack of control of that segment = failed load transfer
Pht
- Stabilize the ring (segment) that was translating/rotating
- Ask pt to repeat sitting/prone arm lift with arm that felt heavier q Look for any changes in easiness to do the test
Tx spine hypomobility in extension kinetic test
Tx spine Hypermobility Stability test (SAL)
Tx spine Hypermobility Stability test (PAL)
Tx spine PAL/SAL stability tests part 2
also see slides 24/25
Cx spine - shoulder abduction test
Cx spine - what are the 4 radiculopathy screening tests?
Cx spine - spurling A test
Cx spine hypermobility biomechanical Ax - test 1
Pt:
- Supine, crook-lying position
- Cx spine in neutral/towel under head as needed
- Front 1/3 of tongue on the roof of the mouth, lips together, teeth slightly apart
Pressure Biofeedback Unit (PBU):
- Placement: behind the suboccipital spine
- Inflate to 20 mm Hg
Look/palpate for any compensations…
- Substitution outer unit: SCM, anterior scalene
- Lost of Cx spine neutral position
- If cannot talk or swallow while holding the contraction
- Look for any rigidity (can do some wiggle!!!)
Cx spine hypermobility biomechanical Ax - test 2
Pht:
Look for any compensations
-Outer Unit muscle substitution
- Suboccipital muscle substitution
- Lost of Cx spine neutral position
- Look for any rigidity (can do some wiggle!!!)
TOS Adson
Cx spine hypermobility biomechanical Ax - test 3
Pht:
Look for any compensations
- Outer Unit muscles
- Flexor ms will be activated but should not dominate
- Substitution: SCM, Scalene
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
Cx spine hypermobility biomechanical Ax - test 4
Pht:
Look for any compensations
- Outer Unit muscles
- Extensor ms will be activated but should not dominate
- Substitution: Levator scapulae
- Ext Cx, Tx or Lx spine
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
TOS - ROOS
TOS - hyperabduction
Hyperabduction for symptoms
Hyperabduction for pulse
TOS - Tinels sign
