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Picture

Differential Diagnosis:                                                                             Cervical Radiculopathy or Peripheral Ulnar Nerve Tension

10/8/2014

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Overview
As autonomous practitioners the ability to perform differential diagnosis is more important than ever. Proper differential diagnosis is the difference between treating an impairment versus treating the cause of a patient's problem. It is the difference between decreasing a patient's pain today and eliminating their movement dysfunction forever. Part of this process should include assessing the joints above or below the region of dysfunction. In this post, I want to pose this question: 

How do you determine if a patient is having ulnar nerve adverse neural tension or a movement dysfunction consistent with C8-T1 radiculopathy? 

Picture
Common Features
On initial examination, both diagnoses will have a similar presentation. In both scenarios the patient may have positive upper extremity neural tension tests, weakness and/or muscle atrophy of the hand intrinsic muscles, pain along the ulnar nerve distribution, and potentially cervical segmental nerve dysfunction. How do you differentiate? Two key features that will distinguish the difference between the peripheral nerve tension and C8-T1 radiculopathy are 1. test the strength of the extensor pollicis longus (EPL) and 2. perform specific sensation testing of the affected upper extremity.   

The Difference
While the EPL muscle arises from the C8 nerve root (similar to ulnar nerve), it is innervated by the posterior interosseous nerve (a branch of the radial nerve). If the EPL muscle is intact, the C8 nerve root must be functioning normally. Therefore, the dysfunction is most likely a peripheral ulnar nerve entrapment. If the nerve root is the region of compromise all muscles, not only those innervated by the ulnar nerve, will be affected. The second method of assessment is checking the pattern of sensory loss. Ulnar nerve sensory loss affects the medial one and a half digits. Contrarily, the C8 nerve root can have pain from the lower scapula down the posteromedial aspect of the arm into the ring and little finger. 

The differences may seem subtle, but if a practitioner only suspects ulnar nerve tension, they are neglecting the cervical spine. As part of your differential diagnose make sure to assess the joint above and below the dysfunction. 

Now who remembers how to MMT the EPL... 

-Jim  



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  • Home
    • Newsletter
    • About
  • Featured Articles
    • Sports Physical Therapy >
      • Functional Return to Sport Testing
    • Residency Corner >
      • Research Articles
    • Cervical Course
    • Lumbar Course
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Let Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
  • Insider Access
  • HEP
    • Neck and Shoulder >
      • Supine Chin Tuck
      • Supine DNF with Towel Assist
      • Supine DNF
      • Standing Chin Tuck Against Wall
      • Standing Chin Tuck Against Wall with Scaption
      • Seated Cervical Retraction Repeated
      • Seated Cervical Retraction with Extension Repeated
      • Seated Cervical Retraction with Sidebend Repeated
      • Seated Cervical Retraction with Rotation Repeated
      • Standing Wall Shrugs at 90 Degrees Flex
      • Seated Thoracic Whips
      • Standing Ballistic Shoulder Extensions
      • Standing Repeated Shoulder Extension with Squat
      • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
      • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
      • Seated with Arms on Pillows Shrugs
      • Seated with Arms on Pillows Shrug with Scapular Retraction
      • Supine Shoulder IR with GH Centralization
      • Supine Shoulder ER with GH Centralization
      • Holding Dumbbell at 180 Degrees Flexion for Time
      • Cat Camel
      • Prone T's
      • Prone Y's
      • Quad Chin Tuck w/ Shoulder Flexion
    • Low Back >
      • Supine TA Isometric
      • Standing TA Isometric Agains Wall with Squat
      • Supine BKFO
      • Quad Rock Back
      • Standing Hip Hinge
      • Sit to Stand with Hip Hinge
      • Repeated Lumbar Sideglides
      • Repeated Standing Lumbar Extension
      • Repeated Standing Lumbar Flexion
      • Repeated Prone Press-Ups
      • Repeated Supine DKC
      • Slump Sciatic Nerve Glides
      • Birddog Progression
    • Hip and Knee >
      • Clamshells with Progressions
      • Fire Hydrants with Progressions
      • Donkey Kicks
      • Bridge Variations
      • Repeated Hip Flexion
      • Squats
      • Seated Repeated Knee Extensions
      • CKC Seated Repeated Knee Extensions
      • Heel Slides
      • CKC DF with Tibial IR
    • Foot and Ankle >
      • Calf Raises
      • Calf Raises with Soccer Ball Between Medial Malleoli
      • Towel Scrunches with Foot in PF
      • Toe Flexion Using T-Band with Foot in PF
      • PF with Toes Flexed Using T-Band
      • DF with Toes Flexed Using T-Band
      • Forefoot Adduction
      • Gastroc Stretch
      • Repeated PF
    • Examination Templates
  • Store
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