Upper Limb Neuro dynamics

Question 1

What is Neuro dynamics

Answer 1

Nerve movement

Question 2

What are the indications for a neurological examination in the cervical spine?

Answer 2

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

Question 3

How to test myotomes, reflexes and dermatomes

Answer 3

Myotomes- resisted testing
Reflexes- tendon jerk when using tendon hammer
Dermatomes- light touch, in

Question 4

How do you test myotomes?

Answer 4

Isometric testing
Mid position for the muscle being tested
Need to assess C1-T2

Question 5

How do you test level C4?

Answer 5

Tests -Spinal accessory nerve, and muscles are upper traps and Levatoe scapulae. The therapist should resist shoulder elevation

Question 6

How do you test levels C5-6?

Answer 6

Tests the Axillary nerve and muscles Deltoid + supraspinatus
Therapist should resist shoulder abduction
Patient pushes up, therapist resists this movement

Question 7

How do you test levels c5-C6

Answer 7

It tests the musculo-cutaneous nerve and muscles Biceps and Brachialis.
The therapist should resist Elbow flexion

Question 8

How to test levels C6-7-8

Answer 8

It tests the radial nerve and muscles triceps.

The therapist should resist elbow extension

Question 9

How to test C7-C8?

Answer 9

It tests the PIN nerve and muscles EPL. The therapist should resist thumb extension

Question 10

How to test C7-8-T1?

Answer 10

This tests the AIN and Ulnar nerve and FDP muscles. The therapist should resist finger tip flexion

Question 11

How to test levels C8-T1?

Answer 11

It tests the ulnar nerve, interossei and the lumbricals. The therapist should resist finger addiction and finger abduction

Question 12

What does a hyper reflexic reflex mean

Answer 12

There is a UMN lesion (any damage to the motor neurone that reside above nuclei of cranial nerves

Question 13

What does a hypo reflexic reflex mean?

Answer 13

This refers to any disorder producing loss of function of the lower motor neuron supply to somatic musculature

Question 14

What does an absent reflex mean?

Answer 14

There is a LMN lesion

Question 15

What is a ULTT?

Answer 15

Upper Limb Tension Test

Question 16

What is a ULTT 1 for the Median Nerve

Answer 16

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

Question 17

How to perform the ULTT2b on the radial nerve?

Answer 17

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.

Question 18

How the test the ULTT3 on the ulnar nerve?

Answer 18

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.

Question 19

How can a bias be placed when testing a nerve in the upper limb?

Answer 19

Tilt head and neck into side flexion

Depress or undepress the shoulder girdle

Question 20

What are the most common types of nerve root issues in the cervical spine?

Answer 20

Herniated discs 25-28%

Antigenerative disc disease -70-75%

Question 21

What nerve root level has the highest level of injury.

Answer 21

C5-C6

Question 22

How do you assess c6

Answer 22

Assess biceps brachii and wrist extensors.
Patient goes into supination and therapist pushes down whilst elbows are flexed.
Check for noticeable bilateral strength differences

Question 23

How do you check for c7 wrist extensors?

Answer 23

Place the patient in supinate position, stabilise arm and clasp hand and resist wrist flexiin

Question 24

How do you assess T1?

Answer 24

Resist abduction force in the index finger

Question 25

What is a neural container?

Answer 25

The nerve slides and glides around bone, muscle, ligaments, fascia, osseous tunnels, so they can have an effect on nerve function and inflammation.

Question 26

What is the aim of assessment?

Answer 26

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.

Question 27

What is mobilising the container?

Answer 27

Stretches, SSTM and nerve flossing

Anything that can stretch out the nerve and can avoid it from being entrapped and pressed.