Brachial
Plexus Tension Test
Clinical Pearl
Although the brachial plexus tension test involves shoulder
joint movement, it also provides maximum stretch on the brachial plexus, which
affects the lower branches of the cervical spine (C5) the most. If this test is
positive, the early stages of a C5 nerve root disorder may be present along
with the subtle signs of a positive doorbell sign (pain that occurs at the
superior scapulovertebral border and radiates with the use of deep palpation of
the C5 segment) and pain in the deltoid area. The deltoid pain is often
misconstrued as an articular problem of the shoulder.
Dejerine’s
Sign
Clinical Pearl
Patients with radicular symptoms and pronounced Dejerine’s
sign, especially if it is in the lumbar spine, should be told to bend the knees
and lean into a wall during a cough or sneeze. This maneuver reduces
intradiscal pressure and minimizes the effect of the cough or sneeze on the
nerve root. A more worrisome situation is the sudden, unexpected absence of
Dejerine’s sign when all other clinical findings indicate an active nerve root
compression. The loss of the sign indicates fragmentation of the disc with
momentary decompression of the nerve.
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