Cervical and Thoracic spine 2008. 06. 17

Upper limb tension test 1 Tension on C5, C6, C7 nerve root Median nerve dominant Not specific with regard to a given level Median N. 관련된 1 – 3 root의 자극, 압박

Shoulder abduction Arm on examiner’s Rt thigh examiner’s Rt hand on shoulder Examiner’s Lt hand grasp Rt hand

Shoulder abduction at 110 degree

Supinate forearm Extend wrist, fingers

Shoulder external rotation 90 degree

Elbow is extended slowly

If nerve root tension present~ Bending neck to be tested, Sx release

Stretching, aching at Antecubital fossa : WNL C5 : lateral detoid and the midarm C6 : dorsal radial aspect of the forearm involving index finger and the thumb C7 : centrally down the forearm involving the long finger

Upper limb tension test 2 C6, C7 nerve root Median nerve dominant Radial nerve dominant

1) Median nerve dominant Examiner’s left thigh depress pt’s shoulder Shoulder 10 abduction

1) Median nerve dominant Extend elbow External rotation upper limb

1) Median nerve dominant Extend the MCP joint Dorsiflextion the wrist Abducting shoulder to 90 If radicular pain develop, positve finding

2) Radial nerve dominant Elbow extension Internal rotation Flex the wrist, thumb, fingers

Upper limb tension test 3 C8, T1 nerve root Ulnar nerve dominant

Flexed elbow Wrist dorsifexion, forearm supination

Elbow is maximally flexed Examiner’s hand depress the shoulder

Shoulder external rotation, abduction Approximating the hand to his own ear Bend neck away from tested side

Tugging sensation in the axilla : WNL C8 : radiating down the arm past the elbow to the little finger T1 : radiating down the arm past the elbow to the axilla

Axial compression test CIx: Motor deficit is suspected Force should be gentle and gradual Neck, shoulder, upper extremities pain

Distraction test

Spurling’s test Neck is extended, rotated toward the Involved side prior to axial compression Decreasing the dimensions of the nerve Root foramen

Response to Axial compression test and Spurling’s test No discomfort Sensation of heaviness Nonradicular pain Pseudoradicular pain Radicular pain

No discomfort muscular strains mild ligamentous sprains -> pain is not aggravated by test

Nonradicular pain, Pseudoradicular pain radiates to the occiput, scapular, sholders occasionally down the arm but not distal to the elbow 1. Spondylolisthesis 2. Degenerative disc disease without nerve root compression

Radicular pain Radiates into upper extremity Usually below the elbow Along the distribution of dermatome Young adults: intervertebral disc prolapse Older patient: foraminal stenosis owing to the combination of disc degeneration and secondary facet hypertrophy

LHERMITTE’S Maneuver Flex the cervical and the thoracic spine Distal paresthesias in the extremities or the trunk Indicative of spinal stenosis

Nonorganic signs of Waddell Cannot be explained by current knowledge of anatomy & physiology Behavioral maladaptations to disease process or reaction to Real or perceived pain

1. Nonanatomic tenderness by light touch or TD R/O reflex sympathetic dystrophy

2. Simulation sign : low back, entire spine pain Exaggerated response to axial compression test : low back, entire spine pain Rotation simulation maneuver: no torsional force on spine because coplanar with pelvis -> but pain agg.

3. Distraction Sign radicular pain nonorganic Supine + Seated position -

4. Regional sensory or motor disturbance : Stocking, glove distribution Ex) DM neuropathy 2. Motor : diffuse motor weakness of multiple muscle group

5. Overreaction light forms of palpation or gentle examination techniques -> reacts physically or verbally in an inappropriately theatrical manner

다음중 organic pain일 가능성이 높은 상황을 고르세요