00:04 - 00:07This has been of The brookbush Institute in this video. We're going to go
00:07 - 00:10over Upper Limb tension tests. I'm gonna have my friend a vet come out. She's gonna
00:10 - 00:13help me demonstrate. Now, these tests are to help us determine whether the
00:13 - 00:16median owner or radial nerve
00:16 - 00:19are involved in our patient's complaint. We
00:19 - 00:22could see these as trying to find
00:22 - 00:25the concordant sign as part of some
00:25 - 00:28nerve dysfunction. Usually we're
00:28 - 00:32using these tests as part of a cervical ridiculopathy cluster
00:31 - 00:34and we'll be going over that in a
00:34 - 00:37later video. Now. The first thing we want to do with these tests is
00:37 - 00:40notice that the patients in supine laying flat.
00:40 - 00:43We don't want to add any tension to the nervous system. For
00:43 - 00:46example by bringing ourselves up into hip
00:46 - 00:49flexion and Hook Line. We want to make sure that the heads
00:49 - 00:52nice and neutral that we have a stable position.
00:52 - 00:55We continue to come back to and then we're going to ask. Hey,
00:55 - 00:57how is your neck feeling right now?
00:58 - 01:01If somebody has a cervical ridiculopathy and
01:01 - 01:04it is irritable, you'll be surprised. Sometimes people
01:04 - 01:06will get a little nerve symptoms just being
01:07 - 01:10Flat back with their cervical spine a little bit and extension.
01:10 - 01:13So it's important that you kind of rate your starting
01:13 - 01:16symptoms. So, you know if the tests actually
01:16 - 01:17change them
01:18 - 01:21Now what we're going to be doing with these tests is essentially
01:21 - 01:24stretching nerves unfortunately nerves are
01:24 - 01:27a little bit more complicated than muscles as far as trying to
01:27 - 01:31stretch them because they go around so many other joints and
01:30 - 01:34have so many ways of relieving tension
01:33 - 01:36and gaining tension depending on what movements are
01:36 - 01:36added.
01:37 - 01:37So
01:38 - 01:41it gets a little complicated. These are gonna take a little bit of practice but
01:41 - 01:44all of the tests start with this.
01:45 - 01:48This little bit of scapular depression.
01:48 - 01:51And as you can imagine if you think of how those
01:51 - 01:54nerves run right off of the brachial
01:54 - 01:57plexus this would stretch the brachial plexus.
01:57 - 02:01So we just want to start out with hey, did
02:00 - 02:02that increase your symptoms at all?
02:02 - 02:05Okay, so if we know this didn't increase the symptoms now,
02:05 - 02:09we need to start loading the nerve further along. We'll
02:08 - 02:10start with the median nerve.
02:11 - 02:14What you're going to do with the median nerve and what I do guys is I
02:14 - 02:17usually use my fist here to kind of brace and
02:17 - 02:19then I'll use my thigh to help me support the arm.
02:20 - 02:21Okay.
02:21 - 02:24And then we'll go ahead and with the media nerve bring
02:24 - 02:25up to a hundred and ten degrees.
02:27 - 02:29All right. So right about there and go. Hey, how does that feel?
02:30 - 02:31Line if that feels fine.
02:32 - 02:36We're going to now do this funny hand position thing. Alright, you
02:35 - 02:38guys have seen these on some of those nerves tension tests.
02:38 - 02:41I'm sure before but notice how I'm using
02:41 - 02:44my pinky to get across all of her fingers. I have
02:44 - 02:47good purchase of her entire hand. I'm gonna
02:47 - 02:50bring her fingers back into extension her wrist back
02:50 - 02:54into extension and into a little alternate deviation and I
02:53 - 02:55can ask again. How does that feel?
02:56 - 02:59Okay, and I'm gonna bring down to about 90 degrees of external
02:59 - 03:00rotation here. That's okay.
03:01 - 03:05Good, and for most people guys even if they have median
03:04 - 03:07root median nerve involvement.
03:08 - 03:11They're probably still okay here where you usually get things
03:11 - 03:14starting to show some signs of
03:14 - 03:17symptoms is when you go into elbow
03:17 - 03:18extension.
03:20 - 03:23And right about there you can see a vet is starting
03:23 - 03:26to feel it. Now. This actually is not
03:26 - 03:29abnormal and that's not that is something you have to
03:29 - 03:32keep in mind is feeling nervy symptoms.
03:33 - 03:36At let's say within 35 degrees
03:36 - 03:40of elbow extension is not necessarily an
03:39 - 03:42abnormal thing, right? We
03:42 - 03:45need to ask them. Does this bring on the symptoms you
03:45 - 03:45were talking about?
03:46 - 03:49And if it doesn't then it's not what you're looking
03:49 - 03:51for. You might also want to compare sides.
03:52 - 03:56Right if we're talking about a right cervical
03:55 - 03:59ridiculopathy and she's the
03:59 - 04:02same on her right and her left. Well, then we can kind of
04:02 - 04:05determine that this is not as involved. The other
04:05 - 04:08thing you can do for all of these tests is try to
04:08 - 04:09sensitize.
04:10 - 04:14The cervical spine involvement
04:13 - 04:16or sensitize the test to cervical spine
04:16 - 04:20involvement by going. Okay. Let's go lateral flexion.
04:21 - 04:24Increasing tension right and see if that changes this.
04:26 - 04:29If all the sudden she's like oh, right and that brings
04:29 - 04:31on a lot like it magnifies our symptoms.
04:32 - 04:35Then there's a good chance that we have median nerve involvement
04:35 - 04:38from a cervical ridiculopathy. You
04:38 - 04:41could also go the other way we could go. Okay, let's take a bunch
04:41 - 04:44of tension off and see if you get better. Right? So,
04:44 - 04:47you know, the hard part is you got to make sure you get your hand in there
04:47 - 04:50before they get their head down to their shoulder. But if she takes
04:50 - 04:51a bunch of tension off
04:52 - 04:55and all the sudden like all of her symptoms go away.
04:56 - 04:59That's probably a good sign that the cervical spine is involved.
05:00 - 05:04All right guys. So before we go into the other test, let's just take
05:03 - 05:06a quick tally of things that
05:06 - 05:08are going to apply to all your tests.
05:08 - 05:11All of the tests are going to involve this depression
05:11 - 05:14of the shoulder girdle. All right, so that we lengthen
05:14 - 05:17out the brachial plexus all of the tests. You can
05:17 - 05:20sensitize the test to cervical spine involvement
05:20 - 05:23by either increasing tension with lateral flexion
05:23 - 05:26away or decreasing tension with lateral flexion towards
05:27 - 05:29right now the median nerve.
05:30 - 05:33You saw was this funky little movement, right? We're kind
05:33 - 05:33of doing this thing.
05:35 - 05:36So it's
05:37 - 05:41supination and extension of the fingers extension of
05:40 - 05:41the wrists
05:42 - 05:45And then once we get to 110 degrees of
05:45 - 05:45abduction.
05:46 - 05:4890 degrees of elbow extension
05:49 - 05:52We got all of that extended in the hand and wrist then it's
05:52 - 05:55the elbow extension at the end, which is
05:55 - 05:57usually where we start to see funny stuff happen.
05:58 - 06:01Now the owner nerve test.
06:03 - 06:06Is kind of just in the opposite direction. So rather than
06:06 - 06:08supinate we're going to pronate.
06:09 - 06:09rather than
06:10 - 06:13Extend the elbow. We're going to flex the
06:13 - 06:14elbow.
06:15 - 06:18All right you guys with me? So here's what that's going to look like.
06:18 - 06:21You're gonna again depress the shoulder. Hey,
06:21 - 06:24how you doing? It? Everything's okay. Cool back to 110
06:24 - 06:27degrees you okay? Good now watch.
06:28 - 06:30Boom, I just went in the other direction.
06:31 - 06:32Right. How's that feel?
06:33 - 06:36All right. Sometimes you get a little funny stuff. Make sure you guys get the pinky on
06:36 - 06:39this one, right? So make sure you get the pinky extended too. And
06:39 - 06:40then what am I gonna do?
06:41 - 06:42Flex towards her head
06:44 - 06:47Alright, this test is almost like if you
06:47 - 06:50thought about doing this, I don't know if you
06:50 - 06:53guys ever tried to make that face. I can't do it evidently. I have smaller nerves nerve
06:53 - 06:56a my older nerve is not as
06:56 - 06:59extensible as some other people's but if you think about this test for
06:59 - 07:02ulnar nerve and you think about this for median
07:02 - 07:03nerve
07:03 - 07:07you're getting close then it's just a matter of practicing enough.
07:08 - 07:11To get your hand positioned comfortable right? You
07:11 - 07:14guys can notice here that again I'm using my thigh to help.
07:15 - 07:18Now the last one we're going to do which is a little different is
07:18 - 07:20the radial nerve.
07:22 - 07:23now again
07:24 - 07:27Start with depression. Okay. How does
07:27 - 07:27that feel?
07:28 - 07:28That's okay.
07:29 - 07:32Now in this one, I'm going to
07:32 - 07:33ask her to hold her thumb.
07:35 - 07:36Alright, so she's gonna do this.
07:37 - 07:40Because we want we want thumb flexion.
07:41 - 07:43I'm going to totally internally rotate.
07:44 - 07:45and pronate the form
07:46 - 07:49right internally rotate the shoulder pronate the form. Hey,
07:49 - 07:52how does that feel and then the last step? And
07:52 - 07:55again I use my thigh to help me maintain some
07:55 - 07:59elbow extension here is we're gonna add duct or
07:58 - 08:00kind of locked out arm. How does that feel?
08:01 - 08:03now once again guys
08:04 - 08:07feeling feeling nervy stuff.
08:08 - 08:11You know like the little tingly or little shock
08:11 - 08:14once you get out like here is actually pretty
08:14 - 08:15normal.
08:15 - 08:18Right. So let's not let's not make a
08:18 - 08:21positive out of something. That's just normal uncomfortability.
08:21 - 08:24Keep going back to does that bring on
08:24 - 08:27the symptoms you were talking about that concordant sign thing.
08:28 - 08:31Right that was actually fairly normal extensibility
08:31 - 08:34that she felt we saw she had Fairly normal
08:34 - 08:37extensibility on the median nerve test the ulnar
08:37 - 08:39nerve test. She actually had almost like
08:40 - 08:43She had great mobility throughout that position and had
08:43 - 08:46no symptoms at all. So so far with a vet. We're seeing
08:46 - 08:49negative involvement of her
08:49 - 08:52median radial and older nerve.
08:53 - 08:54right
08:54 - 08:57So let's go over that last one one more time.
08:58 - 08:59neutral position
09:01 - 09:02her hand was down by her side.
09:02 - 09:04I had her Tucker thumb.
09:04 - 09:07I'm gonna internally rotate you can kind of look at internally rotating
09:07 - 09:10everything, right so pronation internal rotation of
09:10 - 09:12the shoulder flexion of the wrist.
09:12 - 09:15And then I pull out and abduction checking all
09:15 - 09:18along the way. How do you feel how do you
09:18 - 09:18feel?
09:19 - 09:19How do you feel?
09:20 - 09:21How do you feel?
09:22 - 09:22Good.
09:23 - 09:26Better to be annoying than then did not
09:26 - 09:29ask because if if she was brought on symptoms here,
09:29 - 09:32but you didn't ask until here and then thought she
09:32 - 09:34was normal that's going to give you a false negative.
09:35 - 09:39Right now could I sensitize this test? Absolutely. Can
09:38 - 09:41you laterally flex your head away good?
09:43 - 09:46Did that make things worse? No, can you
09:46 - 09:48go the other way?
09:49 - 09:50Did that make things better?
09:50 - 09:54Yeah, it's so it's
09:53 - 09:56still fine. It's still fine. I didn't actually make her symptoms
09:56 - 09:57better. She just saying she's still fine.
09:58 - 09:58All right.
09:59 - 09:59so
10:01 - 10:04these are gonna take some practice guys and these are some of those tests where let's
10:04 - 10:07be real with each other as professionals. If you
10:07 - 10:10haven't done them in a while chances are you're gonna have to look them back
10:10 - 10:13up. So this might be a video that you want to highlight. I definitely have
10:13 - 10:16to look them back up every once in a while because you know, if I
10:16 - 10:19go a little bit of time without seeing a cervical ridiculopathy, there's
10:19 - 10:22no reason to necessarily do these exams.
10:22 - 10:26You're not going to do them with everybody who walks in the door. Now, we
10:25 - 10:28said that all of the tests start
10:28 - 10:31in the Supine position all of them start with a neutral head position.
10:32 - 10:33all of them start with depression
10:34 - 10:36and then the only thing you have to remember.
10:37 - 10:40Is what movements you're trying to create. So are you
10:40 - 10:40trying to do this?
10:41 - 10:44Are you trying to do this? Are you trying to
10:44 - 10:44do this?
10:45 - 10:48If you guys can remember that you're in really good shape.
10:49 - 10:52if the next thing you can remember is that
10:53 - 10:54elbow extension
10:55 - 10:59and elbow flexion are probably the keys for
10:58 - 11:02the median and ulnar
11:01 - 11:04nerve tests. And abduction is
11:04 - 11:08the key for the radial nerve test as in those
11:07 - 11:10are the movements that generally give you
11:10 - 11:11an indication.
11:12 - 11:15That this is a positive test you've now taken it one
11:15 - 11:16step further.
11:17 - 11:18and of course
11:20 - 11:23when you have complicated things like this as we've said in manual
11:23 - 11:26therapy videos over and over again. Do me a favor.
11:26 - 11:30practice these on your colleagues first colleagues who
11:30 - 11:33can give you some feedback on how it feels so that
11:33 - 11:36before you do this on a patient and look like,
11:36 - 11:37you know,
11:37 - 11:40Muppet hands and just have no
11:40 - 11:40court like
11:42 - 11:44and now it's supposed to be something like
11:45 - 11:48not you want you want it you want to be confident and in the way you look
11:48 - 11:48with these right?
11:49 - 11:52You want to be able to go right into the position and know
11:52 - 11:55whether or not you've loaded this
11:55 - 11:58nerve and that takes just a little bit of practice. If you
11:58 - 12:01guys have any questions leave it in the comments box below. I look
12:01 - 12:01forward to hearing from you.