We're going to be doing some orthopedic special tests and
we don't diagnose in massage therapy, we assess.
Special tests,
if you look at the research on them,
they're not the best for diagnosing
and we don't do that so
it's not a problem for us. What they are pretty good at is identifying
tissue lesions by compressing your shearing forces of the tissue.
So a special test is used to identify a particular tissue that may be a problem.
So they're pretty good at that, but they're not very good at being very
specific about what that tissue might be.
There could be a variety of things. So with a diagnostic
basically, or a diagnosis, is saying that's what it is.
Well special tests aren't the greatest for that, but they will identify problems in
the area many times.
So we use them as a rule in massage therapy and they're an important part
of the evaluation process.
So I'm going to be talking about some of the tests that I like. The go-to
tests that I use. Some of the things I found over the years related to special tests and
different common orthopedic conditions at each joint.
So why don't we start off with doing
the cervical spine, foraminal compression test
and talk about these.
Primarily there used to identify, in the cervical spine,
problems with
the disc prolapse
or bone spurs, spondylolisthesis, spondylitis.
As well they're often very good to identify
facet joint problems.
So if the person is exhibiting sharp shooting pain down the
arm or into the hand, tingling, numbness, paresthesia,
you might consider there might be a nerve problem.
And they do help to
identify if it is a nerve
problem related to a nerve root problem.
And if isn't a nerve root problem, but you are getting generalized pain from
the neck into the shoulder, it may be facet joint irritation.
So they will help to identify those things. So we'll start with Spurling's.
Spurling's is a classic
foraminal compression test, it narrows the foraminal space.
And so I'm just going to step behind Meghan here. Now you can do it in two ways. You can stand behind
the person or you can stand beside them and do it.
If you want to see their expression on their face and stay in contact with them you can stand beside them and do it, but I'm going to stand behind her.
So what you want to do is you want to laterally, so if this, if she's getting sharp shooting pain going down
this arm,
I'd take her to the opposite side first,
clear this side. So you do a lateral flexion and then you
want to push straight down in a straight line, compressing
and seeing if there's any discomfort. Is that okay there? >>Yep.
>>We're going to do a distraction, a cervical spine distraction.
If she had sharp shooting pain going down her right arm
this would
theoretically diminish it or relieve the discomfort in the cervical spine and may diminish some of the sharp shooting pain.
And again that would be for a space-occupying lesion.
Okay, just going to grasp here. Grasp in behind the occipital area underneath the jaw
and lift up.
A little bit of movement lifting up.
We're going to be doing the upper limb tension test. These are,
if the person's having
numbness, tingling,
sharp shooting pain
in one or
two fingers
of if they're having numbness and tingling in many of the fingers or most of the hand,
these are somewhat my go-to
special tests. They're pretty good at
finding out if there's a neurological problem whether it's coming from the cervical spine
or a brachial plexus problem.
So
they're quite helpful in finding out if there's some
neurological radicular pain
conditions.
So if the person had
a nerve root lesion
you could do an upper limb tension test because it pulls on the nerve
and when the nerve is pulled upon when it's compressed it's not very happy. Or if you had
brachial plexus issues in through here, compression
by the scalenes or the first rib and the clavicle or the pec minor.
These tests are pretty good at identifying
nerve problems.
And mostly it's the recreation of the person's symptoms while doing these.
Now people that have had concussions
will often test very strongly to
nerve tensioning
and it has to do with the dura mater.
When you pull on the nerve the dura mater seems to
be more resistant with people that have concussions.
Now I found that, I don't know if that's
in the literature or not,
but in clinical practice here at Algonquin
I've noted a number of people that when you do upper limb tension test and they've had concussions
they seem to test much more strongly
for
limited movement of the
peripheral nerves.
So let's do upper limb tension test one. So what we want to do. I'm going to bring
the shoulder up to about 110 degrees
and depending on your size and the person's size you may
alter the way you do these tests. But I'm going to show you how I do them.
Now they recommend that she'll laterally flex her head at the end. I may
put her head
on that side first if it's a client that
doesn't take instructions well you may want to position the head laterally before
you do this
because at the end of the test I would want the person to
laterally flex their head to the opposite side.
If they do it really quickly it can really cause this discomfort with the testing.
So I'm going to
just laterally flex your head
over here,
right there to start with.
I'm going to bring the arm up to 110 degrees.
I'm going to take my right hand. I'm going to place it on top of the shoulder.
I'm going to push down. I'm going to compress it down
like this so the shoulder's compressed down.
I'm going to take this hand
and I'm going to
externally rotate. You're comfortable there? >>Yep.
>>I'm going to turn the wrist
in this direction. I'm feeling a bit of,
a little bit of tension there. What you'll sometimes notice is you'll feel, on the right hand here, you'll
feel the shoulder pull up
when you start pulling the nerve.
Okay there? >>Yep.
>>Now do the ULTT two, which also tests the medial nerve.
I'm going to have Meghan laterally flex her head
just at the end of the test.
So, again, there's many ways of doing this. I'm going to apply
my shoulder
into her shoulder here
or the,
just at the elbow, I'm going to take my elbow,
I'm going to get it underneath her shoulder.
I'm going to bring her hand out in this position.
And I'm just going to push down like this so I'm
depressing
the shoulder itself
and then I'm going to bring the arm out like this. Is that comfortable there? >>Yep.
>>Now could you just slowly laterally flex your head,
there, that's good, I can feel it pulling right there. Good.
So again, same position here.
I've got my bicep into the top of her shoulder and I'm going to
depress the shoulder like this
and I'm going to medially rotate the humerus and the forearm.
Medially rotate, this is for the radial nerve, the ULTT three.
And depress the shoulder, medially rotate
and flex the wrist and just laterally flex your head a little bit. Good.
You feel it pulling there at all? >>Mhmm.
>>Okay and that should be going
into the back of the thumb and the posterior side of the thumb and hand
if it's
the radial nerve.
We're going to do ULTT
four of the
ulnar nerve.
So this is a little trickier.
I'm going to bring
Meghan's wrist up like this. And I'm going to take
my left hand
and let her arm rest on my forearm.
And I've got her
wrist extended,
her fingers
flared a little bit.
I'm going to come up here,
depress the shoulder down,
hold that
and I'm going to bring. You okay so far? >>Yep.
>>I'm going to bring
the fingers up towards the ear
and make sure that I'm depressing the shoulder. Now you can just slowly laterally
flex a little bit. Oh, stop. I can feel a real strong pull there.
Okay and that's good.
We're going to do a shoulder depression and
the shoulder abduction test.
They're somewhat similar to the upper limb tension test in a way where we're stretching this side
and we're compressing this side. So on this side
we're going to,
if they have pain on this side it's more related to,
most likely,
facet joint irritation, if the person's having sharp shooting pain going down this arm.
On this side its more likely facet.
On this side it reproduces the symptoms the person's been having
it's more likely neural-related.
So it's simply laterally flexing the head in this direction
and compressing the shoulder.
You can see and through how it stretches. So similar to the upper limb tension test
between the nerve roots and the clavicle and the pec and the scalenes
I'm doing a nice long stretch here. If the person reacts to that,
reproduces the pain down the shoulder and down in the hand,
it's probably neural-related.
Though on the opposite side if it becomes uncomfortable it's
highly probable it's facet joint problems, and if there's no sharp shooting pain down the arm.
Now the abduction test is simply
bringing the arm up and putting it on top of the head.
Now a person with
a nerve entrapment,
an irritation,
when you take the pressure off the nerve or you
put slacking on the nerve
often the discomfort will diminish.
So this often will diminish the sharp shooting pain or diminish the pain the person's been having
if it's a neural problem related to
the nerve root.
And the other way, of course,
this will
increase by stretching the nerve.
We're going to do the intervertebral artery test for the intervertebral artery.
And how we do that. We're going to have Meghan come off the table, so it brings her head right off
the table here. Great.
And I'm going to rotate her head
and then I'm going to extend it in
the rotated position.
And
if she's having symptoms with the intervertebral artery
she'll have rapid eye movement, nystagmus,
or she'll have dizziness,
lightheadedness. Okay.
That compressed the intervertebral artery.