leprosy tests by aseem

SPECIAL TESTS FOR PERIPHERAL NERVES : HANSEN’S DISEASE

MEDIAN NERVE

COURSE

• 02 roots – Medial Root (C8/T1) and Lateral Root (C5/C6/C8)

• Arm – vascular branches (Brachial A) ; Muscular branches (Pronator Teres)

• Forearm – Muscular (Supf Flexors – Pronator Teres / FCR / PL / FDS) ; Ant Interosseus N (FDP / FPL / Pronator Quadratus) ; Articular ; Palmar Cutaneous Branch (Cutaneous Supply)

• Hand - Thenar Eminence / Lateral Lumbricals (02)

BRACHIAL PLEXUS

THENAR EMINENCE

• A

CUTANEOUS SUPPLY OF HAND

• A

CLINICAL TESTING

• FPL : Flexion of the Terminal Phalanx of 1st digit ; Pt asked to flex terminal

phalanx of thumb while base is steadied by the Examiner

CLINCIAL TESTING

• FDS / FDP (Lat) – Flexion of the Index Finger ; Pt is

asked to clasp hands together, Index finger fails

to flex – POINTING INDEX ;

OSCHNER CLASPING TEST

CLINCIAL TESTING

• A

CLINCIAL TESTING

• ABDUCTOR POLLICIS BREVIS : Abduction of thumb ; A pen is kept at a level

higher than the thumb and the pt is asked to touch the tip of the pen - PEN TEST

CLINCIAL TESTING

• OPPONENS POLLICIS : Opposition of the thumb i.e. swinging movement of thumb across the palm to touch tips of other fingers

Pt is asked to oppose against examiner’s resistance

CLINCIAL TESTING

• a

ULNAR NERVE

COURSE• Medial Cord of Brachial Plexus (C8 / T1)• Branches :

• MUSCULAR : FCU / FDP (medial)• PALMAR CUTANEOUS BRANCH / DORSAL BRANCH• ARTICULAR BRANCH : elbow• SUPERFICIAL TERMINAL : Palmaris brevis• DEEP TERMINAL BRANCH : Abductor Digiti Minimi /

Flexor Digiti Minimi / Opponens Digiti Minimi (HYPOTHENAR EMINENCE) ; Medial Lumbricals (3 / 4) ; Palmar / Dorsal Interossei (04 + 04) ; Adductor Pollicis

COURSE

• aa

HYPOTHENAR EMINENCE

• A

CLINCIAL TESTING

• FCU: Flexion at Wrist – deviates hand to Radial Side

CLINCIAL TESTING

INTEROSSEI

• DORSAL (ABDUCTION OF FINGERS)

EGAWA TEST - Pt is asked to abduct fingers against Examiner’s

resistance; individually tested ; Palm facing

downwards

EGAWA +

• zz

CLINCIAL TESTING

INTEROSSEI

PALMAR

CARD TEST - With palm facing upwards, patient is asked to hold card

between 02 fingers tightly against the pull exerted by Examiner

WARTBERG + / CARD TEST

WARTBERG’S SIGN +

CLINCIAL TESTING

LUMBRICALS

Tested alongwith Interossei by testing Extension at PIP / TIP ; Examiner steadies Proximal Phalanx and Pt asked to extend Middle and Terminal Phalanges against Resistance.

CLINCIAL TESTING

• a

CLINCIAL TESTING

BOOK TEST

Testing 1st Palmar Interossei + Adductor Pollicis ; pt is asked to hold a book between

Extended thumb and fingers with both hands against pulll by the Examiner ; FROMENT’S SIGN + when pt pinches grasp by flexing thumb, using FPL

FROMENT’S SIGN +

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