leprosy tests by aseem
TRANSCRIPT
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 +
THANK YOU