Upper Extremity Compression Neuropathy OSCE Flashcards
Shoulder abduction
C5
Deltoid (Axillary)
Supraspinatus (suprascapular)
Shoulder flexion
C5
Anterior Deltoid
Coracobrachialis (Musculocutaneous)
Shoulder Extension
C5
Posterior Deltoid
Latissimus Dorsi (Thoracodorsal)
Elbow Flexion
C5, C6
Biceps (Musc.)
Elbow extension
C7
Triceps (radial)
Elbow Supination
C6
Supinator (radial)
Biceps (Musc.)
Elbow pronation
C7, C8
Pronator teres (median)
Quadratus (Ant. Interosses)
Wrist extensoin
C6
Extensors (radial)
Wrist flexion
C7
Flexors (median, ulnar)
Fingers extension
C7
Extensors (radial
Finger flexion
C8
Flexors (median, ulnar)
Finger Abd/ Adduction
T1
Abd/adductors (ulnar)
Thumb flexion
C8 Flexion (ant. interosseous, recurrent branch of median)
Thumb extension
C8 Extension (posterior interosseous from radial)
C40 T1 dermatomes
C4 – Superior shoulder C5 – Lateral arm over deltoid C6 – Lateral forearm C7 – Middle finger C8 – Ring/little finger, distal medial forearm T1 – Medial arm
Motor testing of radial nerve
C6,7,8
Wrist extension
Thumb extension
Sensation testing of radial nerve
Dorsal web space b/w thumb &
index finger
Motor testing of ulnar nerve
C8, T1
Abduction-little finger
Sensation testing of ulnar nerve
C8, T1
distal ulnar aspect- little finger
Motor testing of median nerve
C5, 6, 7, 8
thumb pinch
opposition & thumb abduction
Sensation testing of Median nerve
Distal radial aspect- index finger
motor testing of musculocutaneous nerve
C5-7
Biceps
Sensation testing of musculocutaneous nerve
Lateral forearm (Lat Antebrachial cutaneous branch)
Motor testing of axillary nerve
C5,6
Deltoid
Motor testing of axillary nerve
Lateral arm- deltoid patch on upper arm (sup lat cutaneous branch)
Biceps reflex
C5
Deltoid/ Biceps
Sensation= lateral arm-> axillary nerve
Brachioradialis reflex
C6
Wrist extenstion/biceps
Sensation= lateral forearm (musculocutaneous)
Triceps reflex
C7
Triceps/ finger extension/ wrist flexors
Sensation= middle finger (median nerve)
C8
Finger flexion
Hand intrinscis
Sensation= medial forearm (med. antebrachial cutaneous nerve)
T1
Hand intrisics
Sensations= medial arm (medial brachial cutaneous nerve)
Compression test
with head and neck in neutral position add an axial loading force caudally looking for upper extremity pain, paresthesias, or numbness
Spurlings test
Tests nerve root compression/irritation. Tested with axial force in neutral, then extension, then SB/rotation toward; test of high specificity
Positive Compression/spurlings test
Reproduction of symptoms (pain/neurological symptoms in distribution of nerve root)
Distraction test
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
Valsalva test
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.
Anatomic thoracic outlet boundaries
1st ribs, 1st thoracic vertebra, manubrium
Clinical thoracic outlet boundaries
Ribs 1-2, T1-4 vertebrae, manubrium
Structures in thoracic outlet
brachial plexus
subclavian v
subclavian a
3 zones of thoracic outlet boundaries
scalene triangle
costoclavicular space
retropectoralis minor
Roos or EAST test
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)
Adson Test
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
Wrights Hyperabduction Test
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
Halstead Test
Military /Costoclavicular Test
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
First Rib inhalation somatic dysfunction
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
First Rib inhalation somatic dysfunction
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
Most common site for ulnar nerve compression neuropathy
Cubital tunnel
Fromet’s sign tests for the strength of what
adductor pollicis-> weak in ulnar nerve palsy
