J. Scott Pritchard, DO 2012 NADE NATIONAL TRAINING CONFERENCE

1. Pins/Needles 2. Hammer 3. Tuning fork 4. Flash light 5. Measuring tape 6. Calipers 7. Monofilaments- Semmes-Weinstein 8. And

1. numbness- deprived of the power to move or feel normally 2. Tingling - a pricking or stinging sensation or feeling 3. Paresthesia- skin sensation of burning, prickling or tingling with no apparent cause. 4. Pain- an intense unpleasant feeling caused by damaging stimuli

1. Motor – strength – assessed per MRC scale 0/5 no movement-5/5- normal - tone - continuous passive partial contraction of a muscle - atrophy- loss of muscle mass -spasticity- altered tone w/stiffness and involuntary muscle spasms. Ashworth scale – 0 to 5

2. Sensory- temperature touch pinprick proprioception 2- pt discrimination vibration

 Normal 2- pt discrimination 0-4 mm  Intermediate – 5-7 mm  Abnormal > 7mm

3. Coordination – primary assessment of cerebellar function - Smooth combination of both spatial direction and kinetic(forceful) movement - Functional abnormalities can be seen in altered gait, truncal ataxias, dysmetrias of the extremities, altered rapid alternating movements of the upper/lower extremities. (F-T-N and RAM). - Ataxia – impaired coordination

1. Hemiparetic 2. Paraparetic 3. Sensory 4.Steppage 5. Waddling 6.Festination 7. Retropulsion 8. Astasia Abasia

Compressive neuropathy of the median nerve 1. numbness, tingling of the thumb and first two digits of the hand 2. increased numbness and onset of pain 3. sense of weakness or dropping things 4. most intense at night 5. progressive motor and sensory loss

 In one study 64% of 88 hands w/+ Phalen’s test has positive EMG findings  Conversely 51% of 78 hands with negative Phalen’s testing had positive EMG findings  CTS requires both clinical symptoms, findings and EMG evidence to establish its presence and severity

Compressive neuropathy of the ulnar nerve 1. pain and numbness in the elbow 2. tingling, especially ring and 5 th digit 3. weakness in the 4 th /5 th fingers 4. decreased ability to pinch thumb/5 th digit 5. decreased overall hand grip 6. muscle wasting in the hand 7. claw-like deformity of the hand

1. burning pain/allodynia 2. increased pain w/onset of swelling 3. development of osteoporosis and muscle atrophy 4. irreversible contractures and immobility The affected extremity may be cool to touch and appear mottled. Swelling may be present. Extreme sensitivity of the skin to touch. Often unable to tolerate clothing

CRPS I – no demonstrable nerve lesions (RSD, Sudek’s atrophy) CRPS II – obvious nerve damage(causalgia) usually more painful and difficult to control

1. History and physical examination 2. Thermography 3. Sweat Testing 4. EMG 5. Bone scan 6. X-ray findings

1. Waddell’s 2. Leseque(SLR) now nerve stretch test 3. Hoffman’s sign 4. Wartenburg’s sign 5. Pronator drift 6. Gower’s sign 7. Meralgia paresthetica 8. Double-crush syndrome