MSK Tut 2

• Neurointegrity:

  • Babinski - test upper motor neurone
  • Clonus - test upper motor neurone
  • reflexes - test upper and lower motor neurone
  • myotome - test lower motor neurone
  • dermatome - test lower motor neurone
• Neurointegrity test:

  • for pain that is referred beyond the shoulder and if theres special symptoms e.g. anaesthesia, parasthesia
• • referred pain isnt always from nerves (neuropathic) - more electric/sharp symptoms
  • can be somatic referred pain - e.g. from joints, muscles, ligaments, discs, fascia - more dull ache symptoms
  • somatic pain doesnt tend to refer as far as neuropathic pain
• 5 D's and 3N's are for CAD
• nerve roots in the cervical spine are more horizontal, so it must be a huge disc bulge to have caused nerve compression
• Reflexes

  • biceps - tests C5 mainly and C6
  • brachioradialis - tests C6 mainly and C5
  • triceps - tests C7
• Reflexes:

  • looking for hyper or hypo reflexes on affected nerve
• • myotome - muscle supplied by nerve root
  • dermatome - skin supplied by nerve root
• difference between dermatome and cutaneous - learn
• dermatome:

  • touch unaffected area first to show pts what it should feel like - start on unaffected area then do affected side
• dermatome:

  • touch unaffected area first to show pts what it should feel like - start on unaffected area then do affected side
  • ask what the difference they feel is
  • find out which nerve root was affected
• dermatome:

  • touch unaffected area first to show pts what it should feel like - start on unaffected area then do affected side
  • ask what the difference they feel is
  • find out which nerve root was affected
• dont hold pts while doing dermatome test - only cotton wool touches the pts
• Medial nerve provocation:

  • SG fixation, shoulder abduction 90degrees, wrist extension, forearm supination, shoulder ER, elbow extension
• Radial nerve provocation:

  • SG depression, elbow extension, shoulder IR & forearm pronation, wrist & finger flexion, shoulder abduction
• Ulnar nerve provocation:

  • Wrist & finger extension, forearm pronation, elbow flexion, shoulder ER, SG depression, shoulder abduction
• if limb far away from area being stretched moves towards and symptoms are relieved, but when limb far away from area being stretched moves away and symptoms worsen - positive provocation