Upper limb neuro assessment

Question 1

indications for a neurological examination in the Cx

Answer 1

pain in dermatomal distribution, pain from Cx referred beyond the point of the shoulder, altered sensation in UL, pain the UL that may be related to cervical condition, complaints of weakness in a limb

Question 2

Cx spine dermatomes

Answer 2

C4- traps, C5- deltoid, C6- thumb, C7- index and middle finger, C8- ulna side of hand

Question 3

UL- myotomes- spinal accessory nerve, axillary nerve, musculocutaneous nerve

Answer 3

C4- spinal accessory nerve- upper traps and LS- shoulder elevation
C5-6- axillary nerve- deltoid and supraspinatus- shoulder abd
C5-6- musculocutaneous nerve- bicep and brachialis- elbow flex

Question 4

UL- myotomes- radial nerve, PIN, ulnar nerve/ AIN, ulnar nerve

Answer 4

C6-7-8= radial nerve- triceps- elbow ext
C7-8- PIN- EPL- thumb ext
C7-8-T1= AIN and ulnar nerve- FDP- finger tip flex
C8-T1- ulnar nerve= interossei and lumbricals- finger adduction and abduction

Question 5

reflexes

Answer 5

biceps C5/6= head thumb over tendon, rest forearm on your forearm
triceps- C7/8- have shoulder in abd and MR- can rest arm on pillow
brachioradialis- elbow in mid prone- mid forearm

Question 6

what do reflexes mean

Answer 6

hyper-reflexic- UMN lesion (might also look for clonus, hoffmans and babinski response), hyporeflexic (reduced)- LMN lesion or low tone, absent- LMN lesion (haven’t relaxed, could be difficult to elicit, check both sides if one side=problem

Question 7

upper limb tension test (ULTT) or upper limb neural tension (ULNT)

Answer 7

ULTT 1= median nerve bias, ULTT 2a- median nerve, ULTT2b- radial nerve bias, ULTT 3- ulnar nerve

Question 8

ULTT 1

Answer 8

use elbow to depress shoulder, then add abd and then hold upper arm, then use other hand to supinate/ wrist and finger ext, LR shoulder and elbow ext- can be used as outcome measure

Question 9

ULTT 2a

Answer 9

shoulder girdle depression, abd 10°, elbow ext, LR shoulder, wrist and digit ext, abd of shoulder

Question 10

ULTT 2b

Answer 10

wrap fingers around thumb, shoulder girdle depression, 10° abd, MR whole arm

Question 11

ULTT 3

Answer 11

wrist and digit ext, pronation, elbow flex, shoulder girdle depression- with hand, shoulder LR and abd
place hand on shoulder to depress

Question 12

differentiation of nerve pain- pain above elbow

Answer 12

change wrist flex/ext- change in P= likely nerve pain

no change= different source of pain

Question 13

differentiation of nerve pain- pain below elbow

Answer 13

Cx SF towards tested side- change in P= likely nerve involvement, no change- more likely to be different source of pain

Question 14

UL sliders

Answer 14

ULTT 1 position (MN)- flex wrist and side flex away and reverse
UN test position0 decrease elbow flex and wrist ext, and return to starting position

Question 15

UL tensioners

Answer 15

ULTT 1- test position= tensioner
UN- test postion
RN- test postion