OPT 3203-3
NEUROLOGIC PT 2
Special Tests
•
•
•
•
Carpal Compression Test
The examiner holds the supinated wrist in both hands and
applies direct, even pressure over the median nerve in the
carpal tunnel for up to 30 seconds.
Production of the patient’s symptoms is considered to be a
positive test for carpal tunnel syndrome.
o Symptoms: Pain and paresthesia distal to the site
of compression in the distribution of the median
nerve.
This test is a modification of the reverse Phalen’s test.
The test may also involve flexing the wrist 60° before
applying the pressure and whether symptoms are relieved
when the examiner lets go (it may take a few minutes for the
symptoms to be relieved).
o The wrist flexion is felt to make the test more
sensitive.
•
•
•
Flick Maneuver
The patient is seated or standing and complains of
paresthesia in the hand in the median nerve distribution.
The patient is asked to vigorously shake the hands or flick
the wrists.
A resolution of the symptoms after flicking or shaking the
hands is considered a positive test.
Figure 7-68 Flicker maneuver
Figure 7-67 Carpal compression test
•
Froment’s “Paper” Sign
The patient attempts to grasp a piece of paper between the
thumb and index finger.
Figure 7-69.A Start position
Steps
1) The examiner places both thumbs over the carpal tunnel
along the course of the median nerve just distal to the flexor
retinaculum.
•
When the examiner attempts to pull away the paper, the
terminal phalanx of the thumb flexes because of paralysis
of the adductor pollicis muscle, indicating a positive test.
o The patient recruits the flexor pollicis longus
supplied by the anterior interosseus nerve of the
median nerve to pinch the paper.
Figure 7-69.B Thumb flexes when paper is pulled away
(positive test)
2)
3)
Apply a gentle and sustained pressure for 15 seconds to 2
minutes. Observe for symptoms.
The examiner also observes for symptoms upon relief of the
pressure.
1
•
•
•
•
If, at the same time, the metacarpophalangeal joint of the
thumb hyperextends, the hyperextension is noted as a
positive Jeanne’s sign.
Both tests, if positive, are indicative of ulnar nerve
paralysis.
Hand Elevation Test
The patient raises both hands over the head and maintains
the position for at least 3 minutes.
A positive test is indicated if symptoms are reproduced in
the median nerve distribution in less than 2 minutes.
Figure 7-70 Hand elevation test for median nerve
Begin with prone-on-elbows, then slowly extend the elbows to
the patient’s ability.
To further increase tension at the femoral nerve, have the patient
incorporate neck and leg movements.
Neurodynamic Mobilization
•
•
•
•
Femoral Nerve Glides
The femoral nerve is the largest branch of the lumbar plexus
and arises from L2-L4 lumbar nerves.
It descends through the fibers of the psoas major muscle,
beneath the inguinal ligament, into the thigh.
The posterior division innervates all four quadriceps
muscle.
The anterior division provides sensory and motor
innervation.
o The motor division innervates the pectineus and
sartorius muscles.
Prone Nerve Flossing and Tensioning Exercises
Half Push-up, Partial Cobra Position
2
Dynamic Nerve Flossing
Combined Hip Flexor Stretch with Tibial Nerve Mobilization
Lateral Femoral Cutaneous Nerve
Meralgia Paresthetica Nerve Tensioner
Have the patient in a half-kneeling position and stretch the hip
flexors. The arm is raised towards abduction with lateral trunk
flexion. The stretch is sustained for a few seconds.
Meralgia Paresthetica Nerve Floss
3
Tri-planar Psoas Active Stretch
The core should be activated before lifting the pelvis off the
table. Squeeze the gluteal muscles.
Bring the affected side backward with the heel on the floor.
Mini-band Hip Bridges (for hip stability)
Place the band just above the knees. Feet should be hip distance
apart. Contract the core.
Patient instruction: “Push your spine towards the table using
your core.”
4