Dr. Jason Magonye and Dr. Shawn Scott put together and Upper Extremity Neuro Eval session at the Trinity University Sports Medicine workshop.
Complete the CEU course FREE from Methodist San Antonio
Be familiar with the nuero anatomy of the upper extremity
Cranial nerves – remember they are contra lateral
Dermatomes – sensory innervation to the upper extremity
If it is intact distal, it is intact proximal. Start distal and work proximal
Brachial Plexus – 11 min
Latisimus dorsi is the ladder climbing muscle
Subscapular – don’t let them pull their hands off their belly
Supraspinatus – starts abduction until the deltoid takes over.
Hornblower test – teres minor
Ulnar nerve (C7/C8-T1)
Median Nerve (C5-C8, T1) tip of fingers, the palm of the hand
Anterior Interosseous Nerve (AIN) 22 min
Radial nerve – extension nerve (C5-T1)
Posterior interosseous nerve – supinator
Most of the extensors
Nerve Entrapment -24 min
When nerves get entrapped they get irritated.
IF YOU CATCH THEM EARLY YOU CAN PREVENT THE NERVE DESTRUCTION PROGRESSION.
If they are having weakness then we need to really push to have that person looked at
Median nerve entrapment
Pronator syndrome is similar to carpal tunnel syndrome.
Carpal tunnel – positive tinels or phalens
Pronator teres syndrome.
Catch the rest in the podcast or on Facebook.
Do not be afraid to ask your athlete to provide copies of imaging and reports.
16 year old football player who presents with bilateral hand pain. Pushed from behind during a game and landed face down with his hands in front of his body.
During further questioning of his hands symptoms he states that both of his middle fingers were tingling.
Due to the fact that the patient is experiencing bilateral symptoms you must go to the source in which would be the spine (C7 nerve)
Ulnar nerve splits the 4th digit.
If you have someone who presents with tingling and numbness on the inner aspect of the hand you know that is C8.
Radial nerve does not go to the tip of the fingers.
Saddle bronc rider came off his horse and landed on his head. He walked out of the arena and did not complain of neck, head, or arm symptoms. After driving from Colorado to Texas he went to the sports medicine room stating that he had started to experience bilateral middle finger tingling sensations.
Worse thing to do when you have bilateral symptoms, trauma, and numbness and tingling would be to compress the neck.
Range of motion, neurological testing, and gentle palpation are appropriate to perform in the exam. Orthopedic testing would not be appropriate for this exam.
During exam in both case 1 and 2:
Flexion/extension movements caused finger sensations.
Palpation produced “unusual neck pain” at this point your exam is done
Both cases were referred for immediate cervical xrays.
Case #1 Xray findings: Flexion tear drop fracture of the C5 vertebral body with grade 1-11 retrolisthesis of C5 and C6.
Both of them had surgery the next day.
Catch the rest on the podcast or watching the Facebook videos.
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