MSK Tut 13

• • median nerve passes down anterior-medial aspect of forearm and anterior-lateral part of 2nd, 3rd & 4th fingers
  • radial nerve comes from posterior-lateral aspect of forearm and lateral aspect of 5th finger (thumb)
  • ulnar nerve comes from posterior-medial aspect of the forearm and anterior and posterior aspect of the medial aspect of the hand (1st and 2nd finger)

  
• Tinnels test (tapping)

  • can be used for all 3 nerves (median, radial, ulnar)
  • tap for 30 seconds
  • look for nerve symptoms such as anaesthesia, paraesthesia, sharp shooting pain
• Median nerve tests:

  • Tinnels test:
  • for median nerve tap base of wrist, closer to lateral side for 30 seconds - look for neuro symptoms in median nerve distribution
  • Phalens test:
  • compression of median nerve - wrist flexion of both wrists for 1 minute - look for neuro symptoms in median nerve distribution
  • Reverse Phalens test:
  • compression of median nerve - wrist extension of both wrists for 1 minute - look for neuro symptoms in median nerve distribution
• Ulnar nerve tests:

  • Tinnels test:
  • for ulnar nerve tap base of wrist, at the guyons canal, for 30 seconds - look for neuro symptoms in ulnar nerve distribution
  • Froments sign:
  • adductor pollicis brevis is innervated by ulnar nerve - if ulnar nerve is disturbed, it cant maintain adduction - looks like thumbs DIP joint is flexing instead of staying flat
• Radial nerve tests:

  • Tinnels test:
  • for radial nerve tap the anatomical snuffbox, for 30 seconds - look for neuro symptoms in radial nerve distribution
• ULPT 1 tests median nerve
• ULPT 2 tests radial nerve
• ULPT 3 tests ulnar nerve
• Ligament Tests:

  • medial collateral ligament at elbow
  • lateral collateral ligament at elbow
  • ulna collateral ligament at thumb
• Special Tests:

  • Finklestein - for De Quervains tenosynovitis
  • make a fist with thumb inside hand/fingers, then ulnar deviation
  • positive test would be indicated by pain over radial wrist/thumb
  • CMC grind test - for OA
  • grip first metacarpal, push down and twist
  • positive test would be indicated by pain/crepitus at CMC joint
• Accessory movements:

  • Where there is a painful or restricted active and passive movement it is necessary to identify which joints could be at the source
  • Pain provocation to identify location of sours of symptoms
  • Resistance felt from joint and soft tissues (muscle spasm)
  • AP of elbow joint
  • can also be performed at any joint including:
  • Radiocarpal Midcarpal, Intercarpal, Intermetacarpal
  • Fingers: MCP/PIP/DIP
  • Thumb: CMC