Upper Limb Neuro dynamics Flashcards
What is Neuro dynamics
Nerve movement
What are the indications for a neurological examination in the cervical spine?
Pain in the dermatomal distribution
Pain from cervical spine referred beyond the point of the shoulder
Altered sensation in the upper limb
Pain in upper limb may be related to a cervical condition
Complaints of weakness in a limb
How to test myotomes, reflexes and dermatomes
Myotomes- resisted testing
Reflexes- tendon jerk when using tendon hammer
Dermatomes- light touch, in
How do you test myotomes?
Isometric testing
Mid position for the muscle being tested
Need to assess C1-T2
How do you test level C4?
Tests -Spinal accessory nerve, and muscles are upper traps and Levatoe scapulae. The therapist should resist shoulder elevation
How do you test levels C5-6?
Tests the Axillary nerve and muscles Deltoid + supraspinatus
Therapist should resist shoulder abduction
Patient pushes up, therapist resists this movement
How do you test levels c5-C6
It tests the musculo-cutaneous nerve and muscles Biceps and Brachialis.
The therapist should resist Elbow flexion
How to test levels C6-7-8
It tests the radial nerve and muscles triceps.
The therapist should resist elbow extension
How to test C7-C8?
It tests the PIN nerve and muscles EPL. The therapist should resist thumb extension
How to test C7-8-T1?
This tests the AIN and Ulnar nerve and FDP muscles. The therapist should resist finger tip flexion
How to test levels C8-T1?
It tests the ulnar nerve, interossei and the lumbricals. The therapist should resist finger addiction and finger abduction
What does a hyper reflexic reflex mean
There is a UMN lesion (any damage to the motor neurone that reside above nuclei of cranial nerves
What does a hypo reflexic reflex mean?
This refers to any disorder producing loss of function of the lower motor neuron supply to somatic musculature
What does an absent reflex mean?
There is a LMN lesion
What is a ULTT?
Upper Limb Tension Test
What is a ULTT 1 for the Median Nerve
Therapist does shoulder girdle depression, supination of the arm, wrist and finger extension. The therapist then laterallly rotates the elbow and extends until end range or pain is felt during the stretch
How to perform the ULTT2b on the radial nerve?
The therapist should perform shoulder girdle depression, 10 degrees of abduction, extension at the elbow joint, medial rotation of the whole arm and wrist and digit flexion.
How the test the ULTT3 on the ulnar nerve?
The therapist should place the patients hand on therapist lateral side of neck with elbow flexion and full wrist and digit extension. There is also shoulder abduction and lateral rotation and shoulder girdle depression. The joint should be placed into end feel or until pain is felt.
How can a bias be placed when testing a nerve in the upper limb?
Tilt head and neck into side flexion
Depress or undepress the shoulder girdle
What are the most common types of nerve root issues in the cervical spine?
Herniated discs 25-28%
Antigenerative disc disease -70-75%
What nerve root level has the highest level of injury.
C5-C6
How do you assess c6
Assess biceps brachii and wrist extensors.
Patient goes into supination and therapist pushes down whilst elbows are flexed.
Check for noticeable bilateral strength differences
How do you check for c7 wrist extensors?
Place the patient in supinate position, stabilise arm and clasp hand and resist wrist flexiin
How do you assess T1?
Resist abduction force in the index finger
What is a neural container?
The nerve slides and glides around bone, muscle, ligaments, fascia, osseous tunnels, so they can have an effect on nerve function and inflammation.
What is the aim of assessment?
To see if the nerve is involved in symptoms and to find the severity. It can also be used for red flags and for monitoring them. Improve neural circulation . Mobilise the container and floss the nerve.
What is mobilising the container?
Stretches, SSTM and nerve flossing
Anything that can stretch out the nerve and can avoid it from being entrapped and pressed.
