Peripheral Neural

Dynamic Tests
S.HIMALOWA
LAMU
 Dorsal + Ventral Nerve
Roots =spinal nerve &
exits through
Intervertebral Foramen
(IVF) = Nerve Root =
plexus =peripheral nerves
to joints & muscles
Neural plexus
 Brachial plexus: C4-T1
 Intervertebral Foramen (IVF) –Scalenes –First rib –Pect
minor –Axilla –Median, Ulnar and radial nerves
 Lumbar Plexus: L2-4
 IVF –Psoas –Inguinal ligament –Quadriceps –Femoral nerve
 Lumbo-Sacral Plexus: L4-S2
 IVF –Piriformis –Lat Isch Tub –Hamstrings –Tibial and
Common Peroneal nerves
Plexi
Brachial plexus Lumber plexus
Mechanically ONE System through
conduction AND connective tissues
Red Flags

 Cord ‘signs’
 Ataxic type of gait
 Bilat/Quadrilat paraesthesia
 Bladder control [Spastic bladder]
+ Plantar reflex; Clonus
 Cauda Equina ‘signs’
 Saddle anaesthesia
 Bladder control [flaccid bladder]
Basis of neural signs and symptoms

 Injury/inflammation/irritation due to:

 Friction, compression, stretch, disease
Blood supply impaired
Axonal transport disturbed
Connective tissue nociceptors; Hypoxia-
Oedema-Fibrosis
Dysfunctions of the PNS influencing
movement
 Conduction of NR’s. Test:
 Dermatomes: Soft touch sensation
 Myotomes: Muscle power
 Deep tendon reflexes

 Mechanical sensitivity of the neural structures. Test:

 Dynamics/longitudinal mobility
Symptom pointers towards peripheral
neural dysfunction
 [Referred] Pain in specific area/s
 Paraesthesia in specific area/s
 Numbness in specific area/s
 Sensation of swelling, weakness,?
 Fasciculation, Cramping of specific ms
 Atrophy of specific muscles
Signs of neural impairment

Anaesthesia or decreased sensation

Muscle weakness/atrophy
Altered reflexes
Signs of Nerve Root pressure

 Painin the specific sclerotome, dermatome,

myotome
 Muscleweakness/paralysis of specific
myotome[S3&S4 NR’s: Flaccid bladder]
 Paraesthesia/decreasedsensation in specific
dermatome [S3&S4 NR’s: Saddle anaesthesia]
 Altered mechanical sensitivity
What do I examine if I see neural
impairment?
 Conduction
 Mechanical sensitivity
 Themechanical interface: IVF, neural
entrapper muscles, bone canals/tunnels
Class discussion

 Discuss dermatome & myotomes

Dermatomes and Myotomes
How do I test for mechanical sensitivity?

 Pain provocation or muscle reaction

 Neural dynamic tests
 ULNDT 1, 2a, 2b, 3
 Fem nerve test; mid lumbar slump
 SLR; Passive neck Flex; Slump
 Add a distal component to a painful movement
How do I restore the functions of the
PNS?
 Open the mechanical interface
 Restore the normal mobility and conduction of the nerve
which will reduce irritation,
 These will lead to;
 Normal blood supply
 Axonal transport
 Restoration of scarring immobility
Brachial Plexus provocation tests

 ULNDT1: Stabilise shoulder [palpate for upper fibres of trapezius

reaction]; Sh >90 degr Abd, full LR, Elbow 90 degr F, supination,
Wrists/Finger E then do Elbow Ex [add CL CxSF]
 ULNDT2a: Shoulder Depression [NOT Tx or Cx SF] with arm in neutral,
E elbow, LR sh, Sup forearm, Wrist/Finger E [Add Sh Abd or
contralateral (CL) Cx SF]
 ULNDT2b: Sh Depression [NOT Tx or Cx SF] with arm in neutrral, E
elbow, MR sh, Pron forearm, Wrist/Finger F [Add Sh Abd or CL Cx SF]
 ULNDT3: Stabilise shoulder [palpate for UFT reaction]; Sh >90 degr
Abd, full LR, Elbow 90 degr F, pronation, Wrists/Finger E then do
Elbow F [add CL CxSF]
Lumbar plexus/Femoral nerve
provocation test
 FNDT: Sidelying, underneath leg up in >90 degr hip and
knee F, Cx in neutral on pillow. Tested leg: 90 degr Kn F,
support and move into hip E while stabilising the pelvis.
Ask for upper Cx F (then add) Tx slump [stabilise pelvis!]

 Last stage also called mid-lumbar slump

Lumbo-pelvic plexus/Sciatic nerve and
Canal structure dynamics
 SNDT or SLR: Supine [if pillow, always same pillow under head]
Hip F with straight knee. No add or MR [Add and differentiate
DF, PF, Ev, Hip Add, Hip IR, Neck F –as symptoms present]
 Passive Neck Flexion;
 Slump: Supine: upper &/lower Cx F.
 Sitting: Slump Sh above hips, Neck F, Knee E, DF
 Note; differentiation from hamstring, gastroc & soleus from
Neural tissue
Practical
Mechanical sensitivity
Brachial Plexus tests:
Lumbar plexus test:
Lumbo-sacral plexus test:
Dural + plexi test:
Ref

 Diener, I., OMT Evidence Based Professional Development, 2010.

 Gray, H., Gray’s Anatomy.
 Gross, J., Fetto, J. & Rosen E. Musculoskeletal exam, 2009