Trunk/Nerves Special Tests Flashcards by Alicia Allen

tectorial membrane ligament stress test

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transverse ligament stress test

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alar ligament stress test

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Anterior & Posterior atlanto-axial membranes stress test

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vertebral artery testing

Contraindication to testing VA:
- VBI &/or SC S&S on S/A or first part of dizziness protocol

Trauma < than 6 weeks
Cr-Vx lig stress test = (+)ve
Fracture or risk of fracture

Need 45° of rotation to cause blood flow disturbance & at least another 10-15° to have complete obstruction.

Pht must recognize the potential for obtaining false (-)ve

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Neuro exam for cranial nerves

see slides 20-32

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dizziness differentiation tests

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ULNT1

Move almost all the nerves btw neck & hand – median, radial & ulnar n, brachial plexus, spinal ns & Cx n roots

Indications:

Should be performed when a neural component to U/Q pain/sy is present or when pht want to exclude a neural component
This test is particularly relevant in cases where symptoms are localized to the median nerve

Good inter & intra reliability

Normal Responses:

Similar areas of response in both ULNTs
Sensory response was more frequent in ULNT2m than ULNT1
The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1

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ULNT2m

It Ax the median n, brachial plexus, related spinal ns & low Cx n roots

Indications:

When pt’s symptoms are provoked by scap depression
Symptoms are localized to the median nerve
Can be used in preference to the ULNT1 when shoulder problem & want to avoid abd

Distal Manoeuvre:

Cx spine ipsilat side flex or
Releasing scapula depression or
Wrist flexion

Normal Responses:

Similar areas of response in both ULNTs
Sensory response was more frequent in ULNT2m than ULNT1
The nature of the response was more neurogenic (tingling, burning, P&N) in ULNT2m than ULNT1

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ULNT2r

Indications:
- This test is particularly relevant in cases where symptoms are localized to the radial nerve

Posterior shoulder pain
Lateral elbow pain
Dorsal F/A pain (radial tunnel syndrome, de Quervain’s disease)

Distal Manoeuvre:

Cx spine ipsilat side flex or
Release a small amount of pressure from scapula depression or
Wrist extension

Normal Responses:

Posterior/lateral FA & wrist deep pain/stretch
Painful stretch post aspect of hand, lat arm & biceps

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ULNT3

Indications:
- This test is particularly relevant in cases where symptoms are localized to the ulnar nerve

Anterior shoulder
Axilla
Along the medial aspect of the arm & elbow to the hypothenar eminence & 4-5th fingers
C8 radiculopathy
TOS
CuTS
Guyon’s canal syndrom

Distal Manoeuvre:

Cx spine ipsilat side flex or
Release a small amount of pressure from scap depression or
Wrist flexion

Normal Responses:

Stretch sensation in almost any region of the upper limbs
But more common in ulnar distribution
P & N and burning sensation can also occur

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sciatic nerve neuromeningeal testing

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tibial nerve neuromeningeal testing (tibial branch)

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tibial nerve neuromeningeal testing (tibial branch)

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fibular (peroneal) nerve neuromeningeal testing

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sural nerve neuromeningeal testing

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SI Joint - ASIS gap test

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SI Joint - ASIS compression test

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SI joint - thigh thrust

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SI joint - Gaenslen’s test

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SI joint - sulcus thrust

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SI joint forward bending test

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SI joint - standing flexion kinetic test

1) is for SI joint dysfunction
2) is for confirming SI hypermobility/instability

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SI joint - ASLR

Lx spine - prone instability test

Pt: lays only half way up the bed, with the hips flexed, the trunk muscles relaxed & the feet resting on the floor Pht: will do a PA over the most symptomatic SP If provocation of pain is reported....

Lx spine - active straight leg raise (basic scan)

_Normal_ = optimal Lx-Sx functional load transfer - Leg raised = effortless bilaterally - Lx-Sx region = stable (no movt) - Need good activation of IU & OU ms _Abnormal_ - One leg: feels heavier to lift - Lx-Sx region: unstable (movt in ext, flex, rotation, SF of spine) _Grading system (active leg lifting)_ 0= not difficult at all 1= minimally difficult 2 = somewhat difficult 3= fairly difficult 4= very difficult 5= unable to do Optimal ASLR = the only joint moving is the hip & “it is not difficult at all”

Lx spine - ASLR testing inner unit muscle stimulation (3)

Lx spine - ASLR testing outer unit muscle stimulation - anterior sling

(+)ve test if applying compression(s) or activating sling(s) which: - Makes it easier to lift the leg (affected) - More stable Lx-Sx spine (Good sensitivity & specificity with pt SI pain post-portum) Meaning: - When test results are (+)ve, the assumption is that a lack of motor control exists for dynamic stabilization of the pelvic - Load transfer (stability of the Lx-Sx spine) can be helped via the ms that were (+)ve on Ax

Lx spine - ASLR testing outer unit muscle stimulation - posterior sling

Lx spine - assess transferse abdominal ms

Pt: spine in neutral position Pht: palpate IU ms Ax IU ms activation (tension) without any OU ms contraction Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally _Normal:_ Able to activate IU ms alone Deep, slow tension of IU ms No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction) With IU ms activation should be able to breathe normally Activation -10x10sec (Ax how many reps pt can do) _Abnormal: Substitution strategies_ OU ms contraction (causing post rot of pelvis, Lx spine flex/ext) Bulging of abdomen (= Internal oblique ms contraction) Depression rib cage (= rectus abdo ms contraction) Hold breath Not able to hold 10sec, 10x **\*\*exercises slides 19/20**

Lx spine - assess the multifidus ms

Pt: spine in neutral position Pht: palpate IU ms Ax IU ms activation (tension) without any OU ms contraction Ask pt to breathe in & on the breath out gently activate IU ms using one of the strategies (identify the best strategy for your pt), Then breathe normally Normal: Able to activate IU ms alone Deep, slow tension of IU ms No substitution from OU ms contraction (No Lx or pelvic movts, No fast contraction) With IU ms activation should be able to breathe normally Activation -10x10sec (Ax how many reps pt can do) _Abnormal: Substitution strategies_ OU ms contraction (causing post rot of pelvis, Lx spine flex/ext) Ant rotation of pelvis, gripping of buttock ms (= OU ms contraction) Hold breath Not able to hold 10sec, 10x

Lx Spine - assess the pelvic floor ms

Lx spine - femoral nerve sheath mobility

Lx spine - supine TrA test

Lx spine - prone TrA test

Lx Spine - Anterior oblique sling Ax

Lx spine - prone hip extension

Ax the strength, control & firing pattern of the lumbopelvic stabilizers & hip extensor ms - Pt in prone with a pillow under the pelvis (for neutral position of the spine) - Pt is asked to lift a straight leg 8-10 inches off the table

Lx spine - posterior oblique sling - LAT DORSI ms strength

Lx spine sling Ax - Hip Abduction neuromuscular control test

Lx spine sling Ax - Glut medius Isometric (brake) strength test

Lx spine sling Ax - Glut medius ms strength – Trendelenburg test

Tx spine - how to do slump test

Tx spine - sitting arm lift (SAL) test

Part 2: Pht: -Thumbs on SPs & index fingers along the ribs -Ask pt to repeat movt several times with arm that felt heavier to lift -Palpates the ribs individually (+)ve = rib translation or rotation = lack of control of that segment = failed load transfer Pht - Stabilize the ring (segment) that was translating/rotating - Ask pt to repeat sitting/prone arm lift with arm that felt heavier q Look for any changes in easiness to do the test

Tx spine - prone arm lift (PAL) test

Tx spine hypomobility in extension kinetic test

Tx spine Hypermobility Stability test (SAL)

Tx spine Hypermobility Stability test (PAL)

Tx spine PAL/SAL stability tests part 2

also see slides 24/25

Cx spine - shoulder abduction test

Cx spine - what are the 4 radiculopathy screening tests?

Cx spine - spurling A test

Cx spine hypermobility biomechanical Ax - test 1

Pt: - Supine, crook-lying position - Cx spine in neutral/towel under head as needed - Front 1/3 of tongue on the roof of the mouth, lips together, teeth slightly apart Pressure Biofeedback Unit (PBU): - Placement: behind the suboccipital spine - Inflate to 20 mm Hg Look/palpate for any compensations... - Substitution outer unit: SCM, anterior scalene - Lost of Cx spine neutral position - If cannot talk or swallow while holding the contraction - Look for any rigidity (can do some wiggle!!!)

Cx spine hypermobility biomechanical Ax - test 2

Pht: Look for any compensations -Outer Unit muscle substitution - Suboccipital muscle substitution - Lost of Cx spine neutral position - Look for any rigidity (can do some wiggle!!!)

TOS Adson

Cx spine hypermobility biomechanical Ax - test 3

Pht: Look for any compensations - Outer Unit muscles - Flexor ms will be activated but should not dominate - Substitution: SCM, Scalene Progression: - Can change the head angle....be as functional as possible... - Can be given as an exs...

Cx spine hypermobility biomechanical Ax - test 4

Pht: Look for any compensations - Outer Unit muscles - Extensor ms will be activated but should not dominate - Substitution: Levator scapulae - Ext Cx, Tx or Lx spine Progression: - Can change the head angle....be as functional as possible... - Can be given as an exs...

TOS - ROOS

TOS - hyperabduction

Hyperabduction for symptoms Hyperabduction for pulse

TOS - Tinels sign