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Scratch Collapse Test
740 Plays1 year ago
What is it? Does it work?
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Transcript
Introduction to Scratch Collapse Test
00:00:06
Speaker
Hi, I'm Josh McDonald. And I'm Miranda Materi, and we are Hand Therapy Academy. So today we're going to be talking about the Scratch Collapse Test. And first of all, they just want to ask, what is it and are you using it? So it is a test that if you look it up, I want to say it's Dr. Haggard, but there is a doctor who does a ton of research out there.
00:00:31
Speaker
MacKinnon or MacKinnon out of St. Louis? Yes, huge proponent of it. It's this fantastic way to identify if there is nerve compression and dysfunction of peripheral nerves downstream.
00:00:46
Speaker
And so the idea is, and this is the CliffsNotes version, the synopsis, that at different points of, for example, the median nerve pathway, I do a little light scratch along the nerve pathway.
Skepticism and Neurological Explanation
00:00:59
Speaker
I start proximal and I do a little scratch and then test external rotation of the shoulder.
00:01:05
Speaker
If it's fine, I go a little bit more distal, and I keep working my way distal, and with every like little three or four scratch test, I test external rotation, and you work your way distal until you get to, for example, the carpal tunnel. If you're doing ulnar nerve, it would be cubital tunnel all the way down to Guillen's canal, all that. But when you get to a spot where there is compression, maybe it's pronitatory syndrome, maybe it's still sort of fibrosis, anyhow, when you get to that point of compression, you will lose the ability to demonstrate external rotation strength.
00:01:34
Speaker
The three primary external rotators, lateral deltoid, Terry's major, and supraspinatus lose function when you scratch that peripheral nerve. Well, every time I've seen this, I look at that and I think, I don't really understand how that works. Like I was super reluctant to believe in it and to buy into it until a recent article came out.
Nociplastic Pain and Sensory Collapse
00:02:03
Speaker
This article talked about the actual neuropathway that exhibits this function. And this article in Journal of Hand Surgery talked about the presence of a third type of pain. So we know about neuropathic.
00:02:20
Speaker
And we know about nociceptive pain. They discovered this third type, nociplastic pain, and it's present in like fibromyalgia. They said it's also present in irritable bowel syndrome. And this loop that exists is actually, so the sensory of the carpal tunnel nerve coming in that causes tingling and numbness, and then you lose afferent function because of loss of muscle function, muscle wasting.
00:02:47
Speaker
it has a connection to the afferent fibers in other pathways. So they're testing this with EMG testing, and you lose contraction potential of the shoulder external rotators when the peripheral nerve is agitated, and that's what the scratch is. You know, they're calling it sensory collapse now because I think scratch collapse sounded a little less
00:03:12
Speaker
significant, but they're calling it sensory collapse now. So if you see that name, it's just an interesting article. One thing you said, but I know you know that the supraspinatus is not an external material. It's infraspinatus. Yes. Say thank you. Sorry. I know you know that and it's just late here. So I just wanted to clarify for our audience.
00:03:34
Speaker
Yeah, but okay, not to lose the flow, but I think, um, like I've seen them do the scratch collapse test. I've tried it in clinic. You know, I've done it a few times, but I'm like, I
Neurological Evidence vs. Clinical Need
00:03:43
Speaker
don't know. Like, so do you think that the, I guess I need to read the article. Did you feel like after reading the article, it was something you were going to implement in your clinic?
00:03:53
Speaker
So this article did not talk about how to administer the test or the usefulness or application of the test. This article was, hey, we found evidence that shows the neurologic connection between the stimulus of a scratch and the loss of external rotation. So that's what this article is about. Now, to your point, like just trying to prove
00:04:16
Speaker
this class, like the theory behind it. Yes. Versus before we're like, we don't know what the theory is really. We just know it works. Yes. Now they did talk about, um, like they said that the exact dermatome that's in use is unclear. So there's still a little bit of ambiguity with this whole thing. So it's not like locked down, but what in the nervous system is really for sure. No. And I went to one where they were like spraying cold spray, you know, to like,
00:04:45
Speaker
Eliminate the sensory response to freeze it out. I guess so they could work a different. I don't okay. Okay. It's so
00:04:53
Speaker
It's basically something I thought, ah, that's not really like found in good science. I don't really get it. I don't see the link. And now I think, okay, well, maybe there is a neurologic link to this. Then I asked the question, okay, should I be doing this? Do I need to? Does it matter? What does it add to my clinic? Let's say it is 100% legitimate and it totally works. Do I need to use it? And I'm not sure that I do. I think the function of it
00:05:20
Speaker
taking the place of, or being a provocative test. I've got provocative tests for peripheral nerve dysfunction with great sensitivity and specificity. I've got Durkin's, I've got Phelan's, I've got Tenel's, I've got compression versions at proximal, you know, resisted pronation. I've got provocative tests. I don't know that I feel like I need this, but if nothing else, it makes me open to the potential of, hey, this could be something of use.
00:05:46
Speaker
Yeah. So I would love to hear from our audience, you know, as some like send us an email, let us know, are you using
Historical Context and Complexity Concerns
00:05:53
Speaker
this? Um, you know, I think in Josh and I, maybe, you know, we'll put some more thought into it and see if there's any more science that comes out behind it and what we do. Cause it's been around for a while. I would say maybe like what, 10, 15 years. Yeah. And I don't know why it hasn't gotten more traction other than maybe it didn't have this hard science behind it. And it seems a little,
00:06:17
Speaker
I think what had happened initially was that the work came out of St. Louis and the publication showed that it really is a good measure and a good tool to use, but then someone else, I don't know, it was like Michigan or I can't remember where, came out with another study. Basically they were just trying to repeat what was done at St. Louis and they showed that the results were not the same. So they were like, well, it doesn't even work. So then there was like this groups going back and forth and the argument that St. Louis made, the group of St. Louis said, well, hey, you're not doing it right. You don't know how to do it correctly.
00:06:38
Speaker
I don't know
00:06:46
Speaker
So they, you know, so basically they're going back and forth about that. So it's like, well, is it that hard to do correctly? Like, you know, that's a good question. If I'm going to try it, I'm not going to go buy cold spray to have in the clinic. I'm not going to like go to a class on this. When I've got provocative tests, if it's something as simple to learn as Durkin's or Phalen's or Tenel's, sure. Add it to my list of tools in the toolbox. If it's more complicated, I feel like I don't need another tool for that purpose.
00:07:14
Speaker
Right. Yeah. I guess we'll keep our eye out.
Audience Feedback Invitation
00:07:17
Speaker
So definitely reach out to us. If this is something you love and are a huge fan of, if you've got great research that you found that supports it, definitely send it to us. Email it to us info at handtherapyacademy.com. Send it to us on Instagram and direct messages. We'd love to hear from you guys. Or maybe you've got some research that says, yeah, here's something that says it's not so fantastic, but always good, modern, up-to-date research.