upper limb neurological neurodynamic

What are the two main parts of nervous system physical examination?

Neurological examination (nerve conduction/function) and neurodynamic examination (nerve movement/mechanics).

What structures are assessed alongside the nervous system?

Joint and muscle structures.

What are the three key observation/neurological checks for LMN dysfunction?

Observation; reflexes; myotomes (motor function) and dermatomes (sensation).

Which tests can help identify an UMN lesion?

Babinski response and clonus, alongside other neurological findings.

What does a neurological examination assess?

Nerve conduction and function, including motor, sensory and reflex findings.

What does a neurodynamic examination assess?

Nerve movement and the response of neural tissue to movement.

What are the purposes of neurological examination?

Identify precautions/contraindications, clarify history, establish a baseline, localise peripheral versus root involvement, and distinguish CNS from PNS lesions.

What upper-limb symptoms suggest possible LMN involvement?

Spinal pain extending beyond the shoulder; pins and needles/numbness; weakness or clumsiness.

What findings raise concern for UMN/CNS involvement?

Bilateral diffuse non-dermatomal symptoms, gait/balance/coordination disturbance, bowel/bladder changes, saddle anaesthesia, or severe/progressive bilateral deficits.

What is cervical radiculopathy?

Symptoms and signs caused by cervical nerve-root irritation, compression and/or inflammation.

What can cause cervical nerve-root compression?

Narrowing of the intervertebral foramen, such as from a disc bulge or osteophytes.

What symptoms may occur with cervical radiculopathy?

Pain, paraesthesia/anaesthesia, weakness and reduced reflexes.

What are the components of an upper-limb neurological assessment?

Observation; C3/C4–T1 dermatomes; C4–T1 myotomes; biceps, triceps and brachioradialis reflexes; UMN tests.

How can upper-limb dermatomes be assessed?

ASIA key sensory points or circumferential sensory assessment.

What tool can be used for light-touch dermatome testing?

A cotton ball or tissue, lightly dabbed or dragged over key sensory points.

How should sensory findings be recorded?

As normal, decreased, increased, absent, or potentially allodynic; quantify if useful (e.g. percentage or /10).

Why test an unaffected area first during sensory testing?

To demonstrate the task and establish a comparison for the patient's responses.

Which myotome is tested by shoulder elevation?

C4.

Which myotome is tested by shoulder abduction?

C5.

Which myotome is tested by elbow flexion?

C6 (biceps).

Which myotome is tested by elbow extension?

C7 (triceps).

Which movements can test C8?

Thumb extension (EPL) or DIP flexion of the third finger (FDP).

Which movements can test T1?

Fifth-finger abduction (ADM) or finger adduction (interossei).

Which reflex tests are commonly used in the upper limb?

Biceps jerk, triceps jerk and brachioradialis jerk.

Which nerve-root levels are associated with the biceps reflex?

C5–C6.

Which nerve-root level is associated with the triceps reflex?

C7.

Which nerve-root level is associated with the brachioradialis reflex?

C6.

Why compare reflexes bilaterally and repeat them?

To identify asymmetry or a consistent difference; follow the assessment protocol rather than relying on a single response.

What findings can suggest an UMN lesion?

Diffuse bilateral non-dermatomal symptoms, bowel/bladder symptoms, unsteadiness, clumsiness, saddle/glove sensory changes, generalised hyperreflexia or bilateral sensory changes.

How is clonus tested according to these notes?

Apply quick, sustained ankle dorsiflexion with the knee flexed and extended; assess for rhythmic beats.

How is the Babinski response elicited?

Stroke the sole from heel along the lateral border, then across the metatarsal heads with a blunt object.

What is a positive Babinski response?

Extension/upgoing toes; in adults this can indicate UMN involvement.

What is the normal adult plantar response?

Toe flexion/down-going toes (negative Babinski).

What is neurodynamics?

The relationship between nervous-system mechanics and physiology and how they interact.

What are the aims of neurodynamic assessment?

Reproduce symptoms, identify the involved nerve pathway, establish a baseline and identify treatment precautions.

Do positive neurodynamic findings diagnose the cause of mechanosensitivity?

No. Positive findings are not diagnostic of the underlying cause.

What symptom distribution may suggest neural tissue involvement?

Symptoms following lines or clumps at vulnerable sites.

What pain descriptors may suggest neural involvement?

Burning, lancinating, shooting or cramping pain; sensory loss or pins and needles may also occur.

What symptom behaviour may suggest neural involvement?

Random pain or pain that ramps up after a latency period.

What movement-related findings may suggest neural involvement?

Pain with movements that move, elongate or compress the nervous system; antalgic postures may be present.

What are major contraindications/precautions for neurodynamic testing?

Acute nerve-root injury, new/worsening neurological signs, suspected cord/cauda equina symptoms, UMN signs, tethered cord, severe pain, severe headache, dizziness/nausea or serious pathology.

Which symptoms suggest possible cord or cauda equina involvement and require medical referral?

Bilateral symptoms with gait/coordination difficulty, saddle sensory loss, or bladder retention.

What should be done if UMN signs such as Babinski or clonus are present?

Arrange appropriate medical referral rather than proceeding routinely with neurodynamic testing.

Why avoid neurodynamic testing in severe pain?

It may be overly intrusive and provoke symptoms unnecessarily.

How do neurodynamic tests challenge the nervous system?

Multi-joint limb and/or trunk movements alter the length and dimensions of the nerve bed/interface.

What abilities are assessed by neurodynamic tests?

Neural sliding and elongation, and abnormal mechanical sensitivity or physiological responses.

What two methods can examine neural mechanosensitivity?

Nerve palpation and neurodynamic tests.

What should happen before passive neurodynamic testing?

Explain the test and ask the patient to perform it actively first as a quick screen.

How should passive neurodynamic testing be performed?

Use a consistent starting position, test one joint/component at a time, and test the less symptomatic side first.

What should the examiner monitor during neurodynamic testing?

Movement barriers, symptom onset, range reduction, resistance/end-feel and antalgic responses.

What is the aim: evoke or provoke symptoms?

Evoke symptoms briefly and carefully, rather than unnecessarily provoking or aggravating them.

What are sensitising movements used for in neurodynamic testing?

To help differentiate neural contribution to symptoms, when appropriate.

When might the order of neurodynamic movements be varied?

When needed to mimic aggravating or functional positions and movements.

Which nerve is assessed by ULNT 1?

Median nerve.

Which nerve is assessed by ULNT 2a?

Median nerve.

Which nerve is assessed by ULNT 2b?

Radial nerve.

Which nerve is assessed by ULNT 3?

Ulnar nerve.

What are the key indicators of a positive neurodynamic test?

Reproduction of familiar symptoms, symptom change with differentiation, side-to-side ROM difference, or altered resistance/protective response.

What is a differentiating movement in neurodynamic testing?

A movement (e.g. neck flexion or lateral flexion) that changes neural loading and helps assess whether symptoms have a neural component.

Why compare neurodynamic test range with the asymptomatic side?

A meaningful side-to-side difference can support an abnormal response.

What may early or increased resistance during neurodynamic testing indicate?

A protective response or altered mechanosensitivity; interpret with other findings.

How should the examiner move during neurodynamic testing?

Slowly and carefully to detect resistance and minimise unnecessary symptom aggravation.

What should guide orthopaedic/neurological assessment and treatment?

Clinical findings, precautions/contraindications, symptom response and appropriate referral when red flags are present.