UQ Intro & Review Flashcards
Regional Interdependence
-impairment model
-unrelated impairments in a remote region
-if pt presentation is unclear and treatment isn’t working
-pain, ROM, neuro, psychosocial, referred pain
UQ Scan
- Vitals (HR and BP)
- CNs (optional)
- Observation: posture, plumb line, head, face, neck, mouth
- Gait: look for gross abnormalities
- Clear the spine
- UE ROM: All 6 w/ overpressure
- Dermatomes (C4-T2)
- Myotomes (C5-T1)
- DTR: bicep, brachioradialis, tricep
- UMN Testing: Hoffman’s, Babinski, Lhermitte
- Upper Limb Tension Testing (Median)
- Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
- Thyroid (optional)
- Lymph Nodes (neck, and axilla) (optional)
When to Scan
- No obvious MOI
- Proximal Cause for Distal S/s
- Non-mechanical sounding Sx
Observations from Behind
Even: ears, scapula, ribs, arm gaps
Observations from Side
-spinal curves
-ears even with acromion
Observations from Front
Face: pupil dif, CN, scars, eye tracking/bulging
Even: ears, clavicles, nipples, arm gaps
Gait Observations
-decreased WB
-hip, ankle, foot
-BOS
-flat food
-shuffling
Myotome Testing
-fatiguable weakness=nerve root
-constant weakness=MMT
-C5-T1
Dermatome Testing
-test face first
1. “When do you feel it”
2. “Where do you feel it”
3. “Does it feel the same as your face”
-C4-T1
Impaired or intact
Reflex Testing (& grade)
0: no response
1: low
2: normal
3: brisk
4: very brisk
5: sustained/clonus
C5: biceps
C6: brachiorad
C7-C8: Triceps
UMN Signs
Hoffman’s
Babinski
Lhermitte (demyelination of SC)
Clearing the Spine
Normal: flx/ext, LSB, rot
Provocation: compression and distraction, 5-8s
Pain Reproduced w/ Compression:
-herniationn
-end plate/fx
-arthritis
-nerve root
Pain Reproduced w/ Distraction
-spinal lig tear
-tear of annulus fibrosis
-spasm
-dural irritability
-cervical instability
ROM
-Cervical
-Shoulder, elbow, wrist, and hand
- AROM –> reproduction of local s/s
- AROM –> reproduction of remote s/s
- AROM –> no impact on s/s
Slump Test
-test neuromobility
- Hands behind back
- Head and neck flexed
- Lumbar flx
- Straighten knee
- overpressure
- DF of ankle
Pulses (& grade)
-Carotid, axilla, brachial, radial, ulnar
-femoral, popliteal, post tib, dorsalis pedis
0: absent
1: reduced
2: slightly reduced
3: normal
4: bounding
Palpation
-inguinal area, axilla, neck (behind ears and jaw)
-check for swelling, pain
-check thyroid
Median Nerve Upper Limb Tension Testing
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending of head
+ Findings: differences btw sides, different elbow ROM, reproduction of s/s
Neurodynamics
-Dynamic mechanical and physiological properties of NS
-inter and intra neural communication
-neural tissue responds to moving by: gliding, lengthening, compression
Adverse Neural Tension
-abnormal physiological or mechanical response from NS
-limits range/stretch
-neuro s/s
Mechanisms of Neural Adverse Tension
-dura tethered to bony canal and adhesions increase tension
-C6, T6, L4
Site of Vulnurability: Tunnel
-tunnels increase probability of spatial compromise
-friction or trauma
ex: carpal tunnel
Site of Vulnurability: Branches
-where a nerve branches
-harder to move from forces here
ex: radial n at elbow
Site of Vulnurability: Hard Interfaces
-nerve lying on bone or passing throuhg fascia
-easier to compress
Site of Vulnurability: Proximity to Surface
-superficial nerves are more vulnerable to compression
Site of Vulnurability: Adherence to interfacing structures
-nerve more adherent in some places
ex: common fib at head of fibula
Nerve Mechanisms of Injury
-Posture: adaptive shortening
-Trauma: fracture, dislocation
-Extremes of Motion: traction
-Electrical injury
-Compression
3 Signs of a Positive NTPT
- Reproduces Pt s/s
- Movement of distant body part causes responses
- Test differences from L to R
Slump Test (Trunk)
-test neuromobility
- Hands behind back
- Head and neck flexed
- Lumbar flx
- Straighten knee
- overpressure
- DF of ankle
- Pt moves head
Median Nerve ULTT 1
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
Ulnar Nerve ULTT 3
- Use hand to depress scap
- Abduct
- GH ER
- Forearm pronation
- Extend wrist and fingers
- Elbow flexion
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
Radial Nerve ULTT 2
- Use hand to depress scap
- GH IR
- Flexion wrist and fingers
- Forearm pronation
- Elbow extension
- GH ABD
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
Contraindications for Neurodynamic Mobilizations
-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders
Neurodynamic Mobilization Techniques: Tension
-load opposite ends of nerve
-both “on” or “off”
-when glides no longer help
ex: head flx and ankle DF, the head ext and ankle PF
Neurodynamic Mobilization Techniques: Gliding
-load one end of nerve while relieving stress on opposite end
- 1 “on” and 1 “off” then switch
ex: head flx and ankle PF, the head ext and ankle DF
Neurodynamic Mobilization Techniques: Stretching
-load opposite ends of nerve and hold
-7-30s
-both “on” or “off”
-most aggressive
ex: head flx and ankle DF (hold), the head ext and ankle PF (hold)
Double Crush Injuries
-multiple sites of compression injury
-common in UE
-Proximal and distal s/s
treat proximal first
MUST CLEAR
- Vertebral Basilar
- Alar Ligs
- Transverse ligs
Radial Nerve Mobilization
-pt in standing
Glide:
-Waiter tip
-Head toward and add sensitizer
-On and off
Tension:
-Waiter tip
-Head away and add sensitizer
-On and on, off and off
Stretch:
-Waiter tip
-Head away and add sensitizer
-On and on, off and off, hold
Ulnar Nerve Mobilization
Glide:
-Waiter tip with batman
-Head toward and add sensitizer
-On and off
Tension:
-Waiter tip
-Head away and add sensitizer
-On and on, off and off
Stretch:
-Waiter tip
-Head away and add sensitizer
-On and on, off and off, hold
CN Testing
- Olfactory: smell
- Optic: Vision
- Oculomotor: H Test (up down)
- Trochlear: H Test, (down and out)
- Trigeminal: Facial Sensation and Masseter and temporalis
6: Abducens: H Test (lateral)
7: Facial: Taste and Smile
8: Vestibulocochlear: Hear - Glossopharyngeal: Swallow
10: Vagus: Cough
11: Spinal Accessory: Resisted shoulder
12: Hypoglossal: stick toung out
Median Nerve Mobilization
Cleopatra, find sensitizer and stop at that
Glide:
-Waiter tray
-Head toward and Arm extended
-On and off
Tension:
-Waiter tray
-Head away and Arm extended
-On and on, off and off
Stretch:
-Waiter tray
-Head away and Arm extended
-On and on, off and off, hold
Slump Nerve Mobilizations
Glide:
-Slump
-Head back and sensitizer extended
-On and off
Tension:
-Slump
-Head down and sensitizer extended
-On and on, off and off
Stretch:
-Slump
-Head down and sensitizer extended
-On and on, off and off, hold
Contraindications for Muscle Performance Training
-unstable angina
-uncotrolled HTN
-Hypertropic cadiomyopathy
-retinopathy
-pain
-inflammation
