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OS EXAM 3 > Upper Extremity Compression Neuropathy OSCE > Flashcards

Upper Extremity Compression Neuropathy OSCE Flashcards

(47 cards)

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1
Q

Shoulder abduction

A

C5
Deltoid (Axillary)
Supraspinatus (suprascapular)

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2
Q

Shoulder flexion

A

C5
Anterior Deltoid
Coracobrachialis (Musculocutaneous)

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3
Q

Shoulder Extension

A

C5
Posterior Deltoid
Latissimus Dorsi (Thoracodorsal)

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4
Q

Elbow Flexion

A

C5, C6

Biceps (Musc.)

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5
Q

Elbow extension

A

C7

Triceps (radial)

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6
Q

Elbow Supination

A

C6
Supinator (radial)
Biceps (Musc.)

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7
Q

Elbow pronation

A

C7, C8
Pronator teres (median)
Quadratus (Ant. Interosses)

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8
Q

Wrist extensoin

A

C6

Extensors (radial)

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9
Q

Wrist flexion

A

C7

Flexors (median, ulnar)

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10
Q

Fingers extension

A

C7

Extensors (radial

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11
Q

Finger flexion

A

C8

Flexors (median, ulnar)

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12
Q

Finger Abd/ Adduction

A

T1

Abd/adductors (ulnar)

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13
Q

Thumb flexion

A 
C8
Flexion (ant. interosseous, recurrent branch of median)
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14
Q

Thumb extension

A 
C8
Extension (posterior interosseous from radial)
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15
Q

C40 T1 dermatomes

A 
C4 – Superior shoulder
C5 – Lateral arm over deltoid
C6 – Lateral forearm
C7 – Middle finger
C8 – Ring/little finger, distal medial forearm
T1 – Medial arm
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16
Q

Motor testing of radial nerve

A

C6,7,8
Wrist extension
Thumb extension

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17
Q

Sensation testing of radial nerve

A

Dorsal web space b/w thumb &

index finger

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18
Q

Motor testing of ulnar nerve

A

C8, T1

Abduction-little finger

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19
Q

Sensation testing of ulnar nerve

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A

C8, T1

distal ulnar aspect- little finger

20
Q

Motor testing of median nerve

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A

C5, 6, 7, 8
thumb pinch
opposition & thumb abduction

21
Q

Sensation testing of Median nerve

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A

Distal radial aspect- index finger

22
Q

motor testing of musculocutaneous nerve

23
Q

Sensation testing of musculocutaneous nerve

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A

Lateral forearm (Lat Antebrachial cutaneous branch)

24
Q

Motor testing of axillary nerve

25
Motor testing of axillary nerve
Lateral arm- deltoid patch on upper arm (sup lat cutaneous branch)
26
Biceps reflex
C5 Deltoid/ Biceps Sensation= lateral arm-> axillary nerve
27
Brachioradialis reflex
C6 Wrist extenstion/biceps Sensation= lateral forearm (musculocutaneous)
28
Triceps reflex
C7 Triceps/ finger extension/ wrist flexors Sensation= middle finger (median nerve)
29
C8
Finger flexion Hand intrinscis Sensation= medial forearm (med. antebrachial cutaneous nerve)
30
T1
Hand intrisics | Sensations= medial arm (medial brachial cutaneous nerve)
31
Compression test
with head and neck in neutral position add an axial loading force caudally looking for upper extremity pain, paresthesias, or numbness
32
Spurlings test
Tests nerve root compression/irritation. Tested with axial force in neutral, then extension, then SB/rotation toward; test of high specificity
33
Positive Compression/spurlings test
Reproduction of symptoms (pain/neurological symptoms in distribution of nerve root)
34
Distraction test
Doctor places one hand under the patient’s chin & places the other hand around the occiput. The doctor slowly distracts the head. (+) test= alleviation of symptoms indicating central compression or central neuropathy
35
Valsalva test
Pt. holds breath and bears down. (+) test = increased pain/paresthesia, especially in nerve root distribution. Valsalva  ↑ intrathecal pressure. In presence of space occupying lesion in cervical canal, this pressure may cause pain in cervical spine as well as radiation of pain to dermatomal distribution.
36
Anatomic thoracic outlet boundaries
1st ribs, 1st thoracic vertebra, manubrium
37
Clinical thoracic outlet boundaries
Ribs 1-2, T1-4 vertebrae, manubrium
38
Structures in thoracic outlet
brachial plexus subclavian v subclavian a
39
3 zones of thoracic outlet boundaries
scalene triangle costoclavicular space retropectoralis minor
40
Roos or EAST test
Compression of subclavian a. Abduct shoulder to 90º & externally rotate with elbow flexed to 90º; Doc instructs pt to open & close fist for up to 3 minutes (+) = reproduction of symptoms (increased pain at shoulder & down arm, paresthesia, arm pallor, cyanosis and swelling)
41
Adson Test
Tight scalene muscles or 1st rib Locate radial pulse on affected arm. Pt breathes deeply. Doc abducts, extends & ext rotates the shoulder while palpating the radial pulse. Head is extended & rotated toward affected side. (Looking towards dysfunctional side- 1st rib etiology) Then the pt’s head is extended & rotated away from affected side. (looking away from dysfunctional side- tight scalene muscles). (+)= loss or change in pulse (+) test indicates compression of subclavian artery between scalenes, cervical rib, or 1st rib
42
Wrights Hyperabduction Test
NV bundle compressed by tight pectoralis minor Doc locates and monitors the radial pulse on the affected side. The patient is seated. Stand behind the patient and palpate the radial pulse with one hand. Abduct the patient's arm above his or her head with some extension. (+)= loss or change in pulse; exacerbation of pain/paresthesia (+) test indicates neurovascular entrapment by pectoralis minor muscle
43
Halstead Test | Military /Costoclavicular Test
Extend shoulder and caudal pressure on shoulder noting change in radial pulse – NV bundle compressed by clavicle and rib 1 Pt seated with Doc behind pt. Contact the ipsilateral wrist at the radial pulse, extend the shoulder, with elbow extended and wrist supinated and apply caudal pressure on the shoulder (+)= decrease in radial pulse (+) test indicates thoracic outlet syndrome due to decrease space between rib 1 & clavicle
44
First Rib inhalation somatic dysfunction
Tx: ME 1st rib Pump Handle Restriction Pt supine, doc seated at head of the table. Pt’s neck is bent forward, supported by physician. Doc contacts the superior anterior aspect of the dysfunctional rib with thumb (between the 2 heads of the SCM) Pt inhales deeply while doc resists. With exhalation, doc follows rib motion inferiorly. Doc continues to resist inhalation, and exaggerates motion into exhalation. Repeat until motion of the rib is restored
45
First Rib inhalation somatic dysfunction
Bucket Handle Restriction Pt supine, doc at head of table. Doc contacts the superior surface of the first rib posterolaterally (lateral to the SCM) With the other hand, doc flexes the head forward, side-bends toward the dysfunctional rib (relieving tension from the scalene muscles) Pt takes a deep breath – with exhalation, doc follows the rib down and forward into exhalation. With next breath, doc resists inhalation and follows into exhalation. Repeated until motion is restored
46
Most common site for ulnar nerve compression neuropathy
Cubital tunnel
47
Fromet's sign tests for the strength of what
adductor pollicis-> weak in ulnar nerve palsy

OS EXAM 3 (2 decks)

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