leprosy tests by aseem

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SPECIAL TESTS FOR PERIPHERAL NERVES : HANSEN’S DISEASE

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Page 1: Leprosy tests by aseem

SPECIAL TESTS FOR PERIPHERAL NERVES : HANSEN’S DISEASE

Page 2: Leprosy tests by aseem

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)

Page 3: Leprosy tests by aseem

BRACHIAL PLEXUS

Page 4: Leprosy tests by aseem
Page 5: Leprosy tests by aseem

THENAR EMINENCE

• A

Page 6: Leprosy tests by aseem

CUTANEOUS SUPPLY OF HAND

• A

Page 7: Leprosy tests by aseem

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

Page 8: Leprosy tests by aseem

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

Page 9: Leprosy tests by aseem

CLINCIAL TESTING

• A

Page 10: Leprosy tests by aseem

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

Page 11: Leprosy tests by aseem

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

Page 12: Leprosy tests by aseem

CLINCIAL TESTING

• a

Page 13: Leprosy tests by aseem

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

Page 14: Leprosy tests by aseem

COURSE

• aa

Page 15: Leprosy tests by aseem

HYPOTHENAR EMINENCE

• A

Page 16: Leprosy tests by aseem

CLINCIAL TESTING

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

Page 17: Leprosy tests by aseem

CLINCIAL TESTING

INTEROSSEI

• DORSAL (ABDUCTION OF FINGERS)

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

resistance; individually tested ; Palm facing

downwards

Page 18: Leprosy tests by aseem

EGAWA +

• zz

Page 19: Leprosy tests by aseem

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

Page 20: Leprosy tests by aseem

WARTBERG + / CARD TEST

WARTBERG’S SIGN +

Page 21: Leprosy tests by aseem

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.

Page 22: Leprosy tests by aseem

CLINCIAL TESTING

• a

Page 23: Leprosy tests by aseem

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

Page 24: Leprosy tests by aseem

FROMENT’S SIGN +

Page 25: Leprosy tests by aseem

THANK YOU