Neural Integrity Upper Quadrant

• Neural Integrity:

  • always indicated in the presence of peripheral pain which could be referred from the spine - if neurological testing isnt completed when indicated, it is unsafe
  • pain referred to or past the buttock/shoulder
  • altered sensation - paraesthesia or anaesthesia
  • referred pain from spine can be nociceptive pain or neuropathic pain
  • any changes found in neurointegiry testing will support that the referred pain is neural in origin
  • this should then be performed during/at each session dependent on clinical presentation to monitor for improvement or worsening of symptoms
• Upper motor neurone testing:

  • indications: part of any full neurological testing
  • unsteadiness of gait
  • bilateral non-dermatomal distribution of symptoms
  • exaggerated tendon reflex response
  • bowel or bladder dysfunction - can also implicate cauda equina compression
  • Babinski
  • Clonus
  • reflexes:
  • biceps - C5 (mainly) and C6
  • brachioradialis - C5 and C6 (mainly)
  • triceps - C7
• Babinski:

  • test for upper motor neurone lesion
  • normal response: no change in pts toe positions, curling and flexion of toes is also normal
  • positive response (upper motor neurone lesion): big toe extension with fanning of the other toes
  • compare to the other side
• Clonus:

  • test for upper motor neurone lesion
  • normal response: 0 to 3 beats of the foot into plantarflexion
  • positive response (upper motor neurone lesion): foot continues to beat into plantarflexion for more than 3 beats
  • compare to the other side
• Upper & Lower motor neurone testing - Reflexes:

  • assess the integrity of the afferent and motor connections as well as the general sensitivity of the nervous system
  • hyper reflexes indicates a problem within the CNS assessing for an upper motor neurone lesion
  • hypo reflexes indicates a lower motor neurone lesion
• Upper & Lower motor neurone testing - Reflexes:

  • Biceps - C5 mainly and also C6
  • pts seated, relaxed
  • your thumb should be placed over biceps tendon and elbow should be just off full extension
  • strike your elbow - look for contraction of the biceps with associated elbow flexion movement
• Upper & Lower motor neurone testing - Reflexes:

  • Brachioradialis - C6 mainly and also C5
  • pts seated, relaxed
  • thumb should be 1 to 2 cm inferior to the lateral epicondyle on the muscle belly of brachioradialis, apply gentle medial glide to induce a stretch onto the tendon
  • strike thumb - look for contraction of brachioradialis muscle bell and associated elbow flexion movement
• Upper & Lower motor neurone testing - Reflexes:

  • Triceps - C7
  • strike tendon directly just superior to where it inserts onto the olecranon
  • look for muscle contraction in triceps muscle belly with or without associated elbow extension
• Myotome:

  • checks for lower motor neurone lesions
  • a myotome is a muscle or muscle group supplied by a spinal nerve
• Myotome:

  • C1 - cervical flexion
  • C2 - cervical extension
  • C3 - cervical lateral flexion
  • C4 - shoulder girdle elevation
  • C5 - shoulder abduction
  • C6 - elbow flexion
  • C7 - elbow extension
  • C8 - thumb extension
  • T1 - finger adduction
• Dermatome:

  • check for lower motor neurone lesions
  • a dermatome is an area of skin supplied by a spinal nerve
  • make sure pts close their eyes, test unaffected area first, compare both side
  • not to be confused with cutaneous/peripheral - area of skin supplied by a branch of a nerve root
  • if there is dermatomal problems - can further investigations via sharp/blunt or hot/cold