Peripheral Based Tests

Median Nerve Test 1

Median Nerve Test 1

• Indications• medial elbow pain • pain at palmar aspect of wrist, thumb

• Areas of palpation• anterior to ulnar N at brachium • medial to distal biceps tendon • deep to pronator trees • carpal tunnel

Median Nerve Test 1

• Sequence1. Glenohumeral abduction (90-110 deg) 2. GH external rotation (90 deg) 3. Forearm supination 4. Wrist/finger extension 5. Elbow extension

• Structural Differentiation• wrist - proximal symptoms • cervical spine contralateral lateral flexion - distal symptoms

Median Nerve Test 2

Median Nerve Test 2

• Indications• median nerve distribution pain • primarily when provoked by scapular depression

• Areas of palpation• next to ulnar N at brachium • medial to distal biceps tendon • deep to pronator trees • carpal tunnel

Median Nerve Test 2• Sequence

1. Scapular depression 2. Elbow extension 3. External Rotation/Supination 4. Wrist/finger extension 5. GH abduction (if needed)

• Structural Differentiation• scapular depression released - distal symptoms • wrist/fingers released - proximal symptoms

• Sensitizing Movements• cervical spine contralateral lateral flexion

Radial Nerve Test

Radial Nerve Test

• Indications• lateral elbow pain - lateral epicondalgia • lateral forearm pain • radial aspect of wrist/thumb - De Quervains syndrome

• Areas of palpation• radial groove • distal radius

Radial Nerve Test• Sequence

1. Scapular depression 2. Elbow extension 3. Internal Rotation/Pronation 4. Wrist/finger flexion 5. GH abduction

• Structural Differentiation• scapular depression released - distal symptoms • wrist released - proximal symptoms

• Sensitizing Movements• cervical spine contralateral lateral flexion

Ulnar Nerve Test

Ulnar Nerve Test• Indications

• C8 radiculopathy • Thoracic Outlet Syndrome • Cubital Tunnel Syndrome • entrapment at Guyon’s canal

• Areas of palpation• medial brachium, posterior to median N • cubital tunnel • immediately distal to cubital tunnel • Guyon’s Canal

Ulnar Nerve Test• Sequence

1. Scapular depression 2. Wrist/Finger extension 3. Forearm Pronation 4. Elbow Flexion 5. GH external rotation 6. GH abduction

• Structural Differentiation• scapular depression released - distal symptoms • wrist released - proximal symptoms

• Sensitizing Movements• cervical spine contralateral lateral flexion • radial deviation

Musculocutaneous Nerve Test

Musculocutaneous Nerve Test• Indications

• C8 radiculopathy • Thoracic Outlet Syndrome • Cubital Tunnel Syndrome • entrapment at Guyon’s canal

• Areas of palpation• medial brachium, posterior to median N • cubital tunnel • immediately distal to cubital tunnel • Guyon’s Canal

Musculocutaneous Nerve Test• Sequence

1. Scapular depression 2. Elbow Extension 3. Shoulder extension 4. Ulnar deviation of wrist/thumb flexion

• Structural Differentiation• release contralateral lateral flexion of cervical spine • radial deviation of wrist

• Sensitizing Movements• cervical spine contralaterateral lateral flexion

Axillary Nerve Test

Axillary Nerve Test

• Indications• Quadrilateral space symptoms/swimmers, throwers • Posterior/Lateral shoulder pain

• Areas of palpation• quadrilateral space

Axillary Nerve Test• Sequence

1. Contralateral lateral flexion of the cervical spine 2. Scapular depression 3. GH internal rotation 4. GH abduction (if IR doesn’t evoke symptoms)

• Structural Differentiation• release cervical spine contralateral lateral flexion

• Sensitizing Movements• cervical spine contralaterateral lateral flexion

Radial Sensory Nerve Test

Radial Sensory Nerve Test

• Indications• DeQuervains syndrome • thumb pain

• Areas of palpation• distal radius • snuffbox

Radial Sensory Nerve Test• Sequence

1. Scapular depression 2. GH internal rotation/elbow extension/forearm pronation 3. Thumb flexion/adduction 4. Ulnar deviation

• Structural Differentiation• release scapular depression

• Sensitizing Movements• cervical spine contralateral lateral flexion

Straight Leg Raise (SLR)

Straight Leg Raise (SLR)

• Indications• Posterior hip/LE pain • Heel pain

• Areas of palpation• Sciatic Notch • Posterior thigh

Straight Leg Raise (SLR)• Sequence

1. Knee stabilized in extension 2. Hip flexion (no knee flexion allowed)

• Structural Differentiation• ankle dorsiflexion - proximal symptoms

• Sensitizing Movement• hip IR/add • ankle movements discussed in depth later

Tibial Nerve Test

Tibial Nerve Test

• Indications• Heel pain/plantar fasciitis • Medial ankle pain

• Areas of palpation• Tarsal Tunnel • Popliteal space - between two dimples

Tibial Nerve Test

• Sequence1. Dorsiflexion/Eversion 2. Straight Leg Raise Test

• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction

Peroneal Nerve Test

Peroneal Nerve Test

• Indications• anterolateral leg/ankle pain • lumbar radicular pain

• Areas of palpation• posterior to fibular head • tunnel for superficial peroneal nerve • anterior ankle • between extensor hallicus and digitorum tendons

Peroneal Nerve Test

• Sequence1. Plantarflexion/Inversion of the ankle/foot 2. Straight Leg Raise Test

• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction

Sural Nerve Test

Sural Nerve Test

• Indications• lateral ankle/foot pain • cuboid syndrome • peroneal tendinitis

• Areas of palpation• posterior to lateral malleolus

Sural Nerve Test

• Sequence1. Dorsiflexion/Inversion of the ankle/foot 2. Straight Leg Raise Test

• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • addition of slump test • hip IR/Adduction

Femoral Nerve Test

Femoral Nerve Test

• Indications• back pain • thigh/hip flexor pain • knee pain

• Areas of palpation• anterior pelvis/inguinal ligament

Femoral Nerve Test• Sequence

1. passive prone knee flexion

• Structural Differentiation2. passive prone knee flexion 3. passive prone knee flexion with manual stability of

pelvis 4. pressure on pelvis

• Sensitizing Movement• Hip extension

Femoral Slump

pic of femoral slump position

Femoral Slump

• Indications• thigh/groin/hip flexor pain • knee pain

Femoral Slump• Sequence

1. pt in side lying (test side down) with head on a pillow 2. superior knee and hip flexed maximally and held with pt

hand 3. pt flexes cervical spine 4. Therapist then passively flexes the patients knee and

extends the hip

• Structural Differentiation• release of cervical flexion with no change in thoracolumbar

position

Saphenous Nerve Test

Saphenous Nerve Test

• Indications• groin pain • medial knee pain

• Areas of palpation• posterior to tibial plateau??

Saphenous Nerve Test• Sequence

1. Pt is prone 2. knee extension 3. Hip extension 4. Plantarflexion/Eversion

• Sensitizing Movement• Internal rotation of the hip • Contralateral lateral flexion of the lumbar spine

Obturator Nerve Test

Obturator Nerve Test

• Indications• groin pain • pelvic pain

• Areas of palpation• unlikely

Obturator Nerve Test• Sequence

1. Pt is in slump position straddling corner of table 2. neck flexion 3. hip abduction to end range

• Structural Differentiation• release neck flexion

• Sensitizing Movement• contralateral lateral flexion of the lumbar spine

Central Based Tests

Passive Neck Flexion• Indications

• Spinal pain (cervical, thoracic, lumbar) • Clearing test for progression to slump test? • Addition to bilateral SLR, slump test

• Sequence• Passively flex the patients cervical spine • Stabilize the patients thorax through the sternum

Keep in mind the previous slides re: convergence of the nervous system with spinal movement

Bilateral SLR

Bilateral SLR

• Indications• symmetrical or central spinal pain • examine the effect of caudad displacement of the spinal

neural elements

• Sequence• Passively flex the patients hips at the same time • Stabilize the knee to prevent flexion

Bilateral SLR

• Structural Differentiation/Sensitizing Movement• bilateral dorsiflexion

Slump Test

Slump Test

• Indications• assess the dynamics of the central and peripheral nervous

tissue • symptoms at most anywhere (typically spine and LE)

Slump Test• Sequence

1. Patient sitting (knees in front of hips) 2. thoracolumbar slump (maintain sacral angle) 3. Cervical flexion 4. Knee extension 5. Dorsiflexion

• Structural Differentiation• release neck flexion - distal symptoms • release dorsiflexion - proximal symptoms

• Sensitizing Movement• contralateral lateral flexion of the lumbar spine • hip IR/add • specific foot movements for each nerve mentioned

previously