ART Nerve Entrapment & Neurological Assessment 2 — Questions and Answers
Question 1: Tarsal tunnel syndrome involves entrapment of which nerve as it passes behind the medial malleolus?
- Sural nerve
- Deep peroneal nerve
- Posterior tibial nerve (Correct answer)
- Saphenous nerve
Correct answer: Posterior tibial nerve
The posterior tibial nerve passes through the tarsal tunnel posterior to the medial malleolus and can be entrapped, causing pain and paresthesia on the plantar surface of the foot.
Question 2: In ART assessment, a positive Tinel's sign is produced by:
- Sustained compression over a nerve for 30 seconds
- Light percussion over a superficial nerve (Correct answer)
- Passive stretch of the nerve through range of motion
- Resisted contraction of the surrounding muscle
Correct answer: Light percussion over a superficial nerve
Tinel's sign is elicited by lightly tapping (percussing) over the course of a nerve; reproduction of tingling or shooting pain distally is a positive response indicating nerve irritation or entrapment.
Question 3: Which muscle in the wrist/forearm region is a common site of median nerve entrapment known as pronator syndrome?
- Flexor carpi radialis
- Pronator teres (Correct answer)
- Flexor pollicis longus
- Brachioradialis
Correct answer: Pronator teres
The median nerve can be compressed as it passes between the two heads of the pronator teres muscle, producing pronator syndrome with forearm pain and numbness in the median nerve distribution.
Question 4: When assessing for radiculopathy in ART practice, which test compresses the neural foramen by laterally flexing and rotating the head toward the affected side?
- Distraction test
- Spurling's test (Correct answer)
- Jackson's compression test
- Valsalva test
Correct answer: Spurling's test
Spurling's test (or foraminal compression test) involves extending, rotating, and laterally flexing the head toward the symptomatic side while applying downward pressure to narrow the foramen and reproduce radicular symptoms.
Question 5: The thoracic outlet syndrome cluster includes all of the following structures EXCEPT:
- Scalene muscles
- First rib
- Pectoralis minor
- Supraspinatus tendon (Correct answer)
Correct answer: Supraspinatus tendon
Thoracic outlet syndrome involves compression of the brachial plexus and/or subclavian vessels by the scalene muscles, first rib, clavicle, or pectoralis minor; the supraspinatus is not part of this outlet.
Question 6: During neurological testing, loss of the brachioradialis reflex (C6) with intact triceps reflex (C7) most specifically implicates which spinal level?
- C5
- C6 (Correct answer)
- C7
- C8
Correct answer: C6
The brachioradialis reflex is mediated by the C6 nerve root; a diminished or absent reflex with normal C7 (triceps) most specifically points to a C6 nerve root lesion.
Question 7: In ART, the 'cumulative injury cycle' explains nerve entrapment as a progression that begins with:
- Scar tissue formation
- Reduced circulation
- Acute injury or repetitive microtrauma (Correct answer)
- Muscle weakness and atrophy
Correct answer: Acute injury or repetitive microtrauma
The cumulative injury cycle starts with acute injury or repetitive microtrauma that leads to inflammation, edema, reduced oxygen supply, adhesion formation, and eventually nerve entrapment and muscle weakness.
ART Nerve Entrapment & Neurological Assessment 2
Tarsal tunnel syndrome involves entrapment of which nerve as it passes behind the medial malleolus?