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OS EXAM 3 > Upper Extremity Compression Neuropathy OSCE > Flashcards

Upper Extremity Compression Neuropathy OSCE Flashcards

1
Q

Shoulder abduction

A

C5
Deltoid (Axillary)
Supraspinatus (suprascapular)

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2
Q

Shoulder flexion

A

C5
Anterior Deltoid
Coracobrachialis (Musculocutaneous)

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3
Q

Shoulder Extension

A

C5
Posterior Deltoid
Latissimus Dorsi (Thoracodorsal)

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4
Q

Elbow Flexion

A

C5, C6

Biceps (Musc.)

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5
Q

Elbow extension

A

C7

Triceps (radial)

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6
Q

Elbow Supination

A

C6
Supinator (radial)
Biceps (Musc.)

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7
Q

Elbow pronation

A

C7, C8
Pronator teres (median)
Quadratus (Ant. Interosses)

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8
Q

Wrist extensoin

A

C6

Extensors (radial)

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9
Q

Wrist flexion

A

C7

Flexors (median, ulnar)

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10
Q

Fingers extension

A

C7

Extensors (radial

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11
Q

Finger flexion

A

C8

Flexors (median, ulnar)

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12
Q

Finger Abd/ Adduction

A

T1

Abd/adductors (ulnar)

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13
Q

Thumb flexion

A 
C8
Flexion (ant. interosseous, recurrent branch of median)
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14
Q

Thumb extension

A 
C8
Extension (posterior interosseous from radial)
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15
Q

C40 T1 dermatomes

A 
C4 – Superior shoulder
C5 – Lateral arm over deltoid
C6 – Lateral forearm
C7 – Middle finger
C8 – Ring/little finger, distal medial forearm
T1 – Medial arm
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16
Q

Motor testing of radial nerve

A

C6,7,8
Wrist extension
Thumb extension

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17
Q

Sensation testing of radial nerve

A

Dorsal web space b/w thumb &

index finger

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18
Q

Motor testing of ulnar nerve

A

C8, T1

Abduction-little finger

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19
Q

Sensation testing of ulnar nerve

A

C8, T1

distal ulnar aspect- little finger

20
Q

Motor testing of median nerve

A

C5, 6, 7, 8
thumb pinch
opposition & thumb abduction

21
Q

Sensation testing of Median nerve

A

Distal radial aspect- index finger

22
Q

motor testing of musculocutaneous nerve

A

C5-7

Biceps

23
Q

Sensation testing of musculocutaneous nerve

A

Lateral forearm (Lat Antebrachial cutaneous branch)

24
Q

Motor testing of axillary nerve

A

C5,6

Deltoid

25
Q

Motor testing of axillary nerve

A

Lateral arm- deltoid patch on upper arm (sup lat cutaneous branch)

26
Q

Biceps reflex

A

C5
Deltoid/ Biceps
Sensation= lateral arm-> axillary nerve

27
Q

Brachioradialis reflex

A

C6
Wrist extenstion/biceps
Sensation= lateral forearm (musculocutaneous)

28
Q

Triceps reflex

A

C7
Triceps/ finger extension/ wrist flexors
Sensation= middle finger (median nerve)

29
Q

C8

A

Finger flexion
Hand intrinscis
Sensation= medial forearm (med. antebrachial cutaneous nerve)

30
Q

T1

A

Hand intrisics

Sensations= medial arm (medial brachial cutaneous nerve)

31
Q

Compression test

A

with head and neck in neutral position add an axial loading force caudally looking for upper extremity pain, paresthesias, or numbness

32
Q

Spurlings test

A

Tests nerve root compression/irritation. Tested with axial force in neutral, then extension, then SB/rotation toward; test of high specificity

33
Q

Positive Compression/spurlings test

A

Reproduction of symptoms (pain/neurological symptoms in distribution of nerve root)

34
Q

Distraction test

A

Doctor places one hand under the patient’s chin & places the other hand around the occiput. The doctor slowly distracts the head.

(+) test= alleviation of symptoms indicating central compression or central neuropathy

35
Q

Valsalva test

A

Pt. holds breath and bears down. (+) test = increased pain/paresthesia, especially in nerve root distribution.
Valsalva  ↑ intrathecal pressure. In presence of space
occupying lesion in cervical canal, this pressure may cause
pain in cervical spine as well as radiation of pain to
dermatomal distribution.

36
Q

Anatomic thoracic outlet boundaries

A

1st ribs, 1st thoracic vertebra, manubrium

37
Q

Clinical thoracic outlet boundaries

A

Ribs 1-2, T1-4 vertebrae, manubrium

38
Q

Structures in thoracic outlet

A

brachial plexus
subclavian v
subclavian a

39
Q

3 zones of thoracic outlet boundaries

A

scalene triangle
costoclavicular space
retropectoralis minor

40
Q

Roos or EAST test

A

Compression of subclavian a.
Abduct shoulder to 90º & externally rotate with elbow flexed to 90º; Doc instructs pt to open & close fist for up to 3 minutes
(+) = reproduction of symptoms (increased pain at shoulder & down arm, paresthesia, arm pallor, cyanosis and swelling)

41
Q

Adson Test

A

Tight scalene muscles or 1st rib

Locate radial pulse on affected arm. Pt breathes deeply. Doc abducts, extends & ext rotates the shoulder while palpating the radial pulse. Head is extended & rotated toward affected side. (Looking towards dysfunctional side- 1st rib etiology)

Then the pt’s head is extended & rotated away from affected side. (looking away from dysfunctional side- tight scalene muscles).

(+)= loss or change in pulse
(+) test indicates compression of subclavian artery between scalenes, cervical rib, or 1st rib

42
Q

Wrights Hyperabduction Test

A

NV bundle compressed by tight pectoralis minor
Doc locates and monitors the radial pulse on the affected side.
The patient is seated. Stand behind the patient and palpate the
radial pulse with one hand. Abduct the patient’s arm above his
or her head with some extension.
(+)= loss or change in pulse; exacerbation of pain/paresthesia
(+) test indicates neurovascular entrapment by pectoralis
minor muscle

43
Q

Halstead Test

Military /Costoclavicular Test

A

Extend shoulder and caudal pressure on shoulder noting
change in radial pulse – NV bundle compressed by
clavicle and rib 1
Pt seated with Doc behind pt. Contact the ipsilateral wrist at
the radial pulse, extend the shoulder, with elbow extended
and wrist supinated and apply caudal pressure on the
shoulder
(+)= decrease in radial pulse
(+) test indicates thoracic outlet syndrome due to decrease
space between rib 1 & clavicle

44
Q

First Rib inhalation somatic dysfunction

A

Tx: ME 1st
rib
Pump Handle Restriction
Pt supine, doc seated at head of the table. Pt’s neck is bent
forward, supported by physician.
Doc contacts the superior anterior aspect of the dysfunctional
rib with thumb (between the 2 heads of the SCM)
Pt inhales deeply while doc resists. With exhalation, doc
follows rib motion inferiorly. Doc continues to resist
inhalation, and exaggerates motion into exhalation. Repeat
until motion of the rib is restored

45
Q

First Rib inhalation somatic dysfunction

A

Bucket Handle Restriction
Pt supine, doc at head of table. Doc contacts the superior
surface of the first rib posterolaterally (lateral to the SCM)
With the other hand, doc flexes the head forward, side-bends
toward the dysfunctional rib (relieving tension from the
scalene muscles)
Pt takes a deep breath – with exhalation, doc follows the rib
down and forward into exhalation. With next breath, doc
resists inhalation and follows into exhalation. Repeated
until motion is restored

46
Q

Most common site for ulnar nerve compression neuropathy

A

Cubital tunnel

47
Q

Fromet’s sign tests for the strength of what

A

adductor pollicis-> weak in ulnar nerve palsy

OS EXAM 3 (2 decks)

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